Washington Surprise Billing Law

What is Washington Surprise Billing Law?

Washington's Balance Billing Protection Act (RCW 48.49), effective January 1, 2020, prohibits out-of-network providers from balance billing patients for emergency care, behavioral health crisis services, ground ambulance services, and scheduled nonurgent services at in-network facilities. The federal No Surprises Act (NSA), effective January 1, 2022, provides additional protections for ERISA self-funded plans not covered by state law.

Emergency Care Protections

Under Washington law, patients pay only their in-network cost-sharing amounts for emergency care, regardless of the provider's network status. Out-of-network charges cannot be passed to the patient. The insurer is responsible for paying the out-of-network provider, with payment disputes resolved through negotiation or OIC arbitration.

Scheduled Services at In-Network Facilities

When patients receive scheduled nonurgent services at in-network hospitals from out-of-network providers, they pay only in-network cost-sharing. Out-of-network providers cannot balance bill without the patient's advance written consent. Facility notification requirements ensure patients have advance warning of potential out-of-network involvement.

Cost Estimates and Transparency

Washington requires out-of-network providers to give good-faith cost estimates before scheduled services. These estimates help patients make informed decisions about out-of-network treatment and understand their potential liability.

Independent Dispute Resolution

When payment disputes arise, Washington's Office of the Insurance Commissioner administers an independent dispute resolution (IDR) process. OIC-certified arbitrators resolve disagreements between providers and insurers about appropriate payment rates for out-of-network services.

Advance Consent Exception

Patients may voluntarily waive balance billing protections for elective nonurgent services with advance written consent. However, patients cannot waive protections for emergency care or services at in-network facilities.

Frequently Asked Questions

How to Invoke Surprise Billing Protections in Washington

1. Identify the unexpected out-of-network charge — Locate the bill or explanation of benefits showing the out-of-network charge and identify whether the service qualifies for protection.
2. Notify your health plan of the out-of-network charge — Contact your insurer and inform them that you received an unexpected out-of-network bill for a protected service.
3. Request that your insurer pay the claim at in-network rates — Ask your plan to adjust the provider's payment to the in-network rate, which limits your liability to in-network cost-sharing only.
4. Submit a dispute to the Office of the Insurance Commissioner if unresolved — If your carrier denies the adjustment, file a formal complaint with the OIC including documentation of the service and your plan's denial.