Protections from surprise medical billing

Learn about state and federal laws for insurers, providers and ground ambulance that protect patients from getting surprise medical bills for emergency services, including behavioral health emergencies.

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What consumers need to know about surprise or balance billing

You have protections in Washington state against surprise or balance billing for emergency care, emergency behavioral health services, scheduled procedures at certain in-network facilities, and covered ground ambulance services.

Ground ambulance services and surprise billing

A new law protects policyholders from out-of-network charges by Ground Ambulance Service Organizations (GASOs) and bans balance billing for covered emergency and non-emergency ground ambulance transportation.

HIPAA transaction usage requirements

Under WAC 284-43B-040, all carriers must have a process that helps providers and facilities determine if their patient is enrolled in a health plan that is subject to the Washington state Balance Billing Protection Act (BBPA).

Health insurer responsibilities under the Balance Billing Protection Act

Learn about what health insurers must do to comply with the Balance Billing Protection Act (BBPA).

Medical providers responsibilities

Learn about what medical providers must do to comply with the Balance Billing Protection Act (BBPA).

Self-funded group health plan opt-in form/attestation

Each self-funded group health plan that elects to participate in the Balance Billing Protection Act must complete and submit this form and attestation to our office.

Self-funded group health plans and surprise billing

The Federal No Surprises Act protects consumers enrolled in self-funded group health from surprise billing. This includes any emergency services they receive from a behavioral crisis facility.

Pharmacy benefit manager self-funded group health plan opt-in

Submit your self-funded group health plan opt-in form and attestation to gain new rights and protections offered by Washington state’s pharmacy benefit manager (PBM) reform law, E2SSB 5213 (Chapter 242, Laws of 2024).

Self-funded group health plans participating in the Balance Billing Protection Act

The Federal No Surprises Act protects consumers enrolled in self-funded group health from surprise billing. This includes any emergency services they receive from a behavioral crisis facility.

Rulemaking

Learn about rules adopted within the last three years, proposed rules and withdrawn rules. Use the status and audience filters to narrow your search.

For medical providers

Medical providers should be current on how health insurance works and know how they can legally market to patients they treat. We're here to help.

How health insurance works

Learn about some of your most important health insurance rights and protections in Washington state.