It is estimated that 1 in 5 patients will seek medical attention from an out-of-network (OON) clinician. Insurers offer little or no reimbursement for care delivered outside of their network, and physicians may remit the remainder/balance of the bill to the patient, known as “balance billing.”
Recently, Washington’s House of Representatives passed HB 1065 to address balance billing, but it didn’t go far enough to remove patients from reimbursement disputes between clinicians and health plans.
The vast majority of physician groups in Washington are contracted with insurers – meaning that patients are protected from out-of-network bills. However, balance billing is often a symptom of a larger problem – inadequate insurance networks. In recent years, insurers have moved to smaller provider networks, increasing the likelihood patients will be treated by an out-of-network provider.
Why It Matters
On February 8, The Senate Health & Long-Term Care Committee unanimously passed Senate Bill (SB) 5699, (but it hasn’t yet passed a full Senate vote). SB 5699 reflects many amendments that would protect Washingtonians from surprise medical bills as a result of out-of-network billing. However, these amendments were overlooked in HB 1065, so Washington patients are still at risk for surprise billing.