Costs and Bills

  • No one likes to be surprised with unexpected costs when claims or bills come in. Here are some tips to help you sort it out ahead of time, and hopefully avoid paying anything extra.

    How are you billed?

    Preventive care is included in your plan

    Get all of your preventive care, every year. You won’t see bills for this care because it is included in your plan and doesn’t apply to your deductible and out-of-pocket maximum. We pay for it because it’s an important investment in your health. Go to Preventive Health to see what’s included.

    Get care in your network

    When you visit doctors in your network, you will pay the bills until your deductible is met, and then a percent of the costs until your out-of-pocket maximum is met, and the charges are the rates we have negotiated with your network providers.

    If you get care from providers who are NOT in your network, they will charge you rates that are usually higher than our contracted rates. Even if the claims are submitted to us, we will only pay the amount we would ordinarily contract for—and you will be responsible for the rest. That’s called balance billing.

    Ask if any services require preapproval

    Always be clear with your provider that labs, tests, and services that need preapproval are cleared with us before you have the procedure. Make Sure You’re Covered has more detailed information.

    What if a bill or claim doesn't seem right?

    Review the Washington Balance Billing Act

    Starting Jan. 1, 2020, members of individual and family plans—as well as some group plans—in Washington will get the added protection of this Act. It closes some gaps, such as getting emergency care in Washington, Oregon, or Idaho from a hospital or facility not in your plan network. 

    The other scenario the Act affects is if you go to an in-network facility for care, and some of the providers who treat you are not in your plan network. Under this Act, those providers can’t bill you at out-of-network rates. If the facility is in your network, you shouldn’t have to sort out whether any of the care is in or out of network. You should only be charged in-network rates for services such as surgeries, anesthesia, pathology tests, radiology, laboratory, and hospitalist work.

    Here are links to information to help you understand what is in this law:

    While it does apply to all individual and family plans, it may not apply to all group plans, so you’ll need to check with your benefits administrator to find out if you’re included.

    Note: If you ever get a bill or claim that doesn’t seem right, be sure to contact us and we’ll look at it with you.