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On Thursday, April 18, 2019, the Washington State Senate unanimously passed a bill to protect patients from receiving surprise bills for medical care involving providers that are out-of-network in a hospital setting.   House Bill 1065 will end surprise billing (or balance billing) for consumers. 

 According to HB 1065, balance billing will be banned for consumers enrolled in fully insured insurance plans, plans offered to public employees under state health care authority provisions or those enrolled in a self-funded group health plan when the sponsor chooses to opt into this provision.  The bill will also remove consumers from balance billing disputes and require that out-of-network providers and carriers negotiate out-of-network payments. 

What is Surprise Billing? 

Surprise billing occurs when a patient receive care or undergoes a procedure involving staff or facilities that are out of their insurance’s network of contracted providers.  After the procedure or medical care, the patient will then receive an unexpected bill for the difference between what the provider has billed for the care or procedure and what the insurance company is willing to pay.  This has often saddled many with unexpected debt for healthcare costs – even those who have comprehensive healthcare coverage.    

Recent studies show that 1 in 5 emergency room visits and 1 in 10 inpatient procedures lead to potential balance billing. Jane Beyer, senior health policy adviser for the Office of the Insurance Commissioner, says, “I think all of us would agree that it is unrealistic to expect a consumer who has walked into a hospital or been brought into a hospital, whether for an emergency procedure or even for a planned procedure, to know that the pathologist, the radiologist, the anesthesiologist may not be in their health plan network."

Senator Annette Cleveland also acknowledges the burden that surprise billing has placed on consumers, saying, “The financial consequences of these surprise fees can be devastating to a patient or their household. If it’s more than the patient can afford and the bill is sent to collections, no one wins — the provider has to spend enormous effort to get the money and often never gets it, and the consumer’s credit history can be ruined.”

Once Governor Inslee signs HB 1065 into law, consumers in Washington State can receive care without fear of such a bill.  HB 1065 will defend consumers by limiting any out-of-network payments to a “commercially reasonable amount.”   To protect patients, HB 1065 establishes an arbitration process in which the hospital and the out-of-network provider must negotiate their differences in fees, instead of passing additional costs on to patients, and ensures an evenhanded process for settling billing disputes between out-of-network providers and facilities and health carriers.

This removes the consumer as the middle man, and they will no longer be stuck with unreasonable debt for emergency or routine procedures covered by their health insurance. 

Berg Andonian

With more than 30 years of experience in the industry, Berg Andonian is a team of knowledgeable and experienced healthcare advisors that takes pride in helping our clients find the right coverage options for their employees.  Using your unique desires and priorities, we create healthcare, HR and CFO solutions that are beneficial to both your employees and your bottom line.   Call us today so we can help you find the right healthcare solutions for your company!

Published April 23, 2019.