What is "surprise medical billing"?
Surprise billing happens when you are treated by a medical provider at a hospital or facility that you believe is in your health plan's network. On top of your expected out-of-pocket costs, you're also charged the difference between what your insurer has agreed to pay your provider and what your provider believes the service was worth. This amount could be hundreds or thousands of dollars.
Surprise billing is 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 covered by your plan, you would not be surprised when you receive a bill for their services, on top of what your plan covers.
Proposed legislation for 2017 - 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.
His proposed legislation 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. Any billing disputes between the health insurer and the provider would be settled through arbitration.
- Update: Engrossed Substitute House Bill 2114 (www.leg.wa.gov) passed out of the Senate Health Care Committee on March 28. It has a hearing in the Senate Ways and Means Committee on March 31 at 1 p.m.
- The bill passed out of the full House of Representatives with a striking amendment on March 6., The vote was 81 to 17.
- Read Commissioner Kreidler's news release: Surprise billing legislation passes state House of Representatives
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.
Read consumer stories about surprise billing.
Surprise billing in the media
- California medical billing protections prompts call for action in Washington state (www.king5.com)
- Buyer Beware - Ins. Comm. Mike Kreidler (www.king5.com)
- 'I feel potentially robbed,' says local hospital patient (www.king5.com)
- Lawmakers to address medical bill sticker shock (www.king5.com)
- Patient claims medical billing practices "morally wrong" (www.king5.com)