For Consumers

Surprise medical billing

Surprise billing news

What is "surprise medical billing"?

Surprise billing can occur when you're treated for an emergency or scheduled procedure at an in-network hospital or ambulatory surgery facility and are seen by a provider that is not in your plan's network. In addition to your expected out-of-pocket costs, you also get bill for the difference between what your insurer has agreed to pay the out-of-network provider and what they believe the service was worth. This amount could be hundreds or thousands of dollars.

Surprise billing occurs with certain types of providers who may not be contracted with your insurer but who provide services at their in-network facilities. Most often, this includes: anesthesiologists, radiologists, pathologists, and labs. It's also referred to as “balance billing,” however, some balance billing is not a surprise. For example, if you seek care from a provider that you know is not in your plan's approved provider network, you should not be surprised to receive a bill for their services, in addition to what your plan covers.

Proposed legislation - ESHB 2114 (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 negotiated price for the covered services, they would go to binding arbitration. They could not bill the consumer for the amount in dispute.

Share your surprise billing story

If you or someone you know has been impacted by surprise medical billing, we’d like to hear from you. Please email your story and also let us know if we can use your story to help spread awareness of this issue. We may also follow-up with you to see if you'd like to file a complaint about your surprise billing issue.

Read consumer stories about surprise billing.

Surprise billing in the media