For Consumers

Surprise medical billing

Surprise billing news

What is "surprise medical billing"?

Surprise billing occurs when you're treated for an emergency or scheduled procedure at an in-network hospital or surgery facility and are seen by an out-of-network provider. In addition to your expected out-of-pocket costs, you also get a bill for the difference between what your insurer has agreed to pay that provider and what they believe the service was worth. 

How can this happen? 

Some types of providers, including anesthesiologists, radiologists, pathologists, and labs may not be contracted with your insurer even though they provide services at an in-network hospital or facility. 

This practices is also called “balance billing,” however, some balance billing is not a surprise. For example, if you're treated by a provider that you know is not in your plan's network, you shouldn't be surprised to receive a bill for their services, in addition to what your plan covers.

Proposed legislation - HB 1065/SB 5031 (www.leg.wa.gov)

Commissioner Mike Kreidler believes consumers should not be caught in the middle of billing disputes between insurers and providers. He's proposing legislation that would protect people from getting a surprise medical bill when they seek medical services from an in-network facility, but are treated by an out-of-network provider.

If an insurer and provider cannot agree on a price for the covered services, they would go to binding arbitration. They could not bill the consumer for the amount in dispute.

Tell us about your surprise bill

If you or someone you know has received a surprise bill, we’d like to hear from you. Email us your story. We may also follow-up with you to see if you'd like to file a complaint about your surprise billing issue.

See what happened to Jamie Hansen of La Center, WA when she sought emergency care for her son, Ryan.