Know Your Rights Under New Patient Protection Law

Effective Jan. 1, 2020, Washington state law protects patients from surprise or balance billing if they receive emergency care at any medical facility or when they're treated at an in-network hospital or outpatient surgical facility by an out-of-network provider

Surprise billing happens because some types of medical providers, including anesthesiologists, radiologists, pathologists, and labs may not be contracted with your health insurer even though they provide services at a hospital or facility that is in your health plan’s provider network. So, 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 the amount the provider billed for their services. 

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 an in-network facility and receive care from an out-of-network provider. In this case, if an insurer and provider cannot agree on a price for the covered services, they go to arbitration and cannot bill the consumer for the amount in dispute.

For more information visit the Office of Insurance Commissioner Website.

Author
UPMC

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