What is Washington Balance Billing Law?
The Washington Balance Billing Protection Act (RCW 48.49), effective January 1, 2020, prohibits out-of-network providers from balance billing patients for emergency services, behavioral health crisis services, ground ambulance services, and scheduled nonurgent services provided at in-network hospitals. Patients are responsible only for their in-network cost-sharing amounts (deductibles, copays, coinsurance).
Protected Services
- Emergency services: any emergency care at any facility
- Behavioral health crisis services: urgent mental health and substance use treatment
- Ground ambulance services: transport to in-network facilities
- Scheduled nonurgent services at in-network facilities: surgery, imaging, and other planned care by out-of-network providers
Facility Notification Requirements
Washington law requires in-network hospitals to post written notice if out-of-network providers may be involved in patient care. This notice protects patients by ensuring they have advance warning of potential out-of-network charges.
Payment Dispute Resolution
When an out-of-network provider bills a patient who qualifies for protection, the provider and insurer have 30 days to negotiate. If unresolved, the Office of the Insurance Commissioner provides dispute resolution. Violations can result in civil penalties up to $25,000 per violation.
ERISA and Self-Funded Plans
Washington's state law applies to state-regulated health plans. Self-funded ERISA plans may not be subject to state law, but the federal No Surprises Act (effective January 1, 2022) provides similar protections for those plans.
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Frequently Asked Questions
Does Washington's balance billing law cover ambulance services?
Yes. Washington's Balance Billing Protection Act (RCW 48.49) specifically covers ground ambulance services. Patients cannot be balance billed for ambulance services provided to an in-network facility, even if the ambulance provider is out-of-network.
What is the penalty for violating Washington's balance billing law?
Violations of Washington's balance billing law can result in civil penalties up to $25,000 per violation, plus restitution to affected patients. The Office of the Insurance Commissioner enforces these penalties.
How to Dispute a Balance Bill in Washington
- Verify the provider was out-of-network — Check your insurer's provider directory to confirm the provider was not in-network at the time of service.
- Confirm the service qualifies for protection — Verify that your service was emergency care, behavioral health crisis care, ground ambulance service, or scheduled nonurgent service at an in-network facility.
- Contact your carrier and request adjustment to in-network rates — Notify your health plan of the balance bill and request they adjust the provider's payment to the in-network rate.
- File an OIC complaint if unresolved within 30 days — If your carrier does not resolve the dispute within 30 days, submit a formal complaint to the Washington Office of the Insurance Commissioner.
Disclaimer: State laws change. This reference is current as of April 13, 2026. Consult Washington RCW 48.49, the federal No Surprises Act, or a healthcare attorney for definitive guidance on your specific situation.