State Law

Revised Code of Washington-Title 48-Chapter 48.49-Balance Billing Protection Act

08/26/2023 Washington Section 48.49.003

Findings — Intent

OON-Payment Issues
(1) The legislature finds that:
(a) Consumers receive surprise bills or balance bills for services provided at ((out-of-network))nonparticipating facilities or by ((out-of-network))nonparticipating health care providers at in-network facilities;
(b) Consumers must not be placed in the middle of contractual disputes between providers and health insurance carriers; and
(c) Facilities, providers, and health insurance carriers all share responsibility to ensure consumers have transparent information on network providers and benefit coverage, and the insurance commissioner is responsible for ensuring that provider networks include sufficient numbers and types of contracted providers to reasonably ensure consumers have in-network access for covered benefits.
(2) It is the intent of the legislature to:
(a) Ban balance billing of consumers enrolled in fully insured, regulated insurance plans and plans offered to public employees under chapter 41.05 RCW for the services described in RCW 48.49.020, and to provide self-funded group health plans with an option to elect to be subject to the provisions of this chapter ((427, Laws of 2019));
(b) Remove consumers from balance billing disputes and require that ((out-of-network))nonparticipating providers and carriers negotiate ((out-of-network))nonparticipating provider payments in good faith under the terms of this chapter ((427, Laws of 2019)); ((and))
(c) Align Washington state law with the federal balance billing prohibitions and transparency protections in sections 2799A-1 et seq. of the public health service act (P.L. 116-260) and implementing federal regulations in effect on the effective date of this section, while maintaining provisions of this chapter that provide greater protection for consumers; and
(d) Provide an environment that encourages self-funded groups to negotiate ((out-of-network)) payments in good faith with nonparticipating providers and facilities in return for balance billing protections.