December 5, 2019
Washington state’s new Balance Billing Prevention Act takes effect on January 1, 2020. The law is intended to protect patients from getting surprise or balance bills when they receive emergency care at non-contracted hospital or non-emergency surgery or ancillary service at an in-network facility but are seen by a non-contracted provider. Patients are also protected from surprise bills for emergency services provided in non-contracted facilities in Idaho and Oregon.
The mandate applies only to patients on fully-insured health plans offered in Washington state. Self-funded group plans may elect to participate. A standard message, according to OIC rules, will appear within 271 transactions for members protected by the balance billing prevention act.
Non-contracted providers covered under the act can’t bill protected members above the in-network cost sharing amount with date of services after December 31, 2019. Premera will pay our median in-network commercial contracted rate directly to the non-contracted provider in these situations. The Explanation of Payment will clearly state that the surprise billing act applies.
A dispute resolution process for payments for non-contracted services is included in the legislation, as well as various communication and transparency requirements. Providers who continue to illegally balance bill may be referred to the state Department of Health for enforcement.