House Bill 2114 is working its way through the Legislature. It is a well-meaning effort to protect Washingtonians from surprise bills when they get medical care.
It is entirely possible that one of the people treating you does not participate in a given network, even if the facility is. Naturally, you will get a larger-than-expected bill from that provider. This should not happen. Insured patients should have the expectation of coverage when they go to an in-network hospital. But providers have the right to negotiate with insurance companies.
A dispassionate analysis reveals that HB 2114 is the battleground upon which the struggle for the legitimacy of narrow networks is being fought. Insurance companies are progressively narrowing their networks to better control their providers and deliver cost-effective care. Hospitals and physician groups similarly need to pad their margins, so they negotiate hard with insurance companies. Balance billing is the result of failed negotiation.
Restrictions on the practice of balance-billing play into the insurance companies’ hands. They gain market power in negotiating rates by telling physicians to take it or leave. Out-of-network doctors will have to accept the payment anyway, so will have no recourse except to eventually withdraw the service.
We should stop making it easier for insurance companies to avoid paying for needed care.
