January 07, 2020
As reported in the October 15, 2019, edition of Compliance Corner, on May 21, 2019, Gov. Inslee signed the Balance Billing Prevention Act into law. Employers who offer health care benefits to employees through Washington state-regulated health plans should be aware that this law became effective on January 1, 2020. Note that self-insured plans can opt into the law after notifying the Office of the Insurance Commissioner at least 30 days in advance of when it intends to participate in and follow the Balance Billing Protection Act. If the plan is administered by a third-party administrator, that administrator also must comply with the law.
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 in-network facility and receive care from an out-of-network provider. The act also includes arbitration for disputes between insurers and providers regarding the price for those services, a notice requirement describing a patient’s rights and letting them know when they can and cannot be balance billed, and a requirement that the amount an insurer pays an out-of-network provider must be “commercially reasonable” as determined by payments made for the same or similar service in a similar geographic area.
The law involves no new employer compliance obligations, but employers with fully-insured plans should be aware of this law.
Balance Billing Prevention Act » Self-Insured Opt In Process » Arbitration Information »