A Vancouver woman went to the hospital, fearing she had an obstructed bowel. She ended up with a $22,000 surprise bill. A La Center mother’s son had a medical emergency. She ended up with a nearly $100,000 surprise bill. A Washougal woman faced a $227,000 surprise medical bill.
A new Washington law that took effect Jan. 1 aims to eliminate these surprise medical billings. According to Insurance Commissioner Mike Kreidler’s website, “the new Balance Billing Protection Act prevents people from getting a surprise medical bill when they receive emergency care from any hospital or if they have a scheduled procedure (at) an in-network facility and receive care from an out-of-network provider.”
In other words, a person suffering from a medical emergency can go to the nearest hospital and ask to see a doctor, not someone in accounts receivable. If you are already lying in a hospital bed, you don’t have to worry that an out-of-network doctor will read your chart.
There are some caveats. It would only apply to people covered by state-regulated health plans or school and state government plans. Large self-insured employers may opt in, and some have already done so.
Most importantly, it doesn’t give someone carte blanche to opt to receive out-of-network care at in-network prices. But it does give patients reasonable assurance they won’t be penalized by concentrating on their recovery, not their finances.
Under the new law, if you receive a surprise medical bill, you’re not responsible for paying it. Your insurer must pay the out-of-network provider and facility directly. You are only responsible for your in-network cost-sharing, including any co-pays, coinsurance and deductible, according to Kreidler’s office. And all health care facilities need to let you know if they are part of your in-network benefit, both on their website and if you ask. If you overpay, they must give you a refund, and they can’t ask you to waive your rights.
Although Washington consumers are protected by the new law, Congress has yet to pass a bill aimed at ending surprise billing at the federal level, despite President Donald Trump’s blessing.
“So this must end,” Trump said in May. “We’re going to hold insurance companies and hospitals totally accountable.”
By December, negotiators in both houses of Congress and for both parties were optimistic that a deal, endorsed by Trump, was near, according to The Associated Press. They planned to include it in the year-end spending bill. But at the last minute the provisions were removed at the behest of House Ways & Means Committee Chair Richard Neal, D-Mass., who Salon reported has taken tens of thousands of dollars in contributions from the hedge fund owners of a physician staffing group opposed to the measure.
The measure would have established a system of arbitration aimed at resolving disputes over surprise bills. The measure also would limit some out-of-pocket costs for patients facing surprise bills from out-of-network providers. It would let health care providers or insurers seek binding arbitration to resolve disputes over who would have to bear the remaining costs.
Now Neal and Rep. Kevin Brady of Texas, the leading Republican on Ways & Means, are said to favor a watered-down bill that would place billing decisions in the hands of a third-party arbiter. In other words, they think medicine needs more lawyers.
In the meantime, thankfully, most Washington consumers have the new Balance Billing Protection Act to provide some critical care.