Washington Billing Rights

Additional State-Law Protections for Patients with State-Regulated Health Plans

• Washington law allows self-funded group health plans to opt-in to Washington’s Balance Billing Protection Act.
• Insurers are required to tell you, via their websites or on request, which providers, hospitals, and facilities are in their networks. Hospitals, surgical facilities, and providers must tell you which provider networks they participate in on their website or on request.
• If you have an emergency medical condition, mental health or substance use disorder condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes care you receive in a hospital and in facilities that provide crisis services to people experiencing a mental health or substance use disorder emergency. You can’t be balance billed for these emergency services, including services you may get after you’re in stable condition.
• Washington law SSB 5986 also bans balance billing for “ground ambulance services,” which is defined to include:
  • The medical treatment and care rendered at the scene of a medical emergency or while transporting a patient from the scene to an appropriate health care facility or behavioral health emergency services provider when the services are provided by one or more ground ambulance vehicles designed for this purpose; and
  • Ground ambulance transport between hospitals or behavioral health emergency services providers, hospitals or behavioral health emergency services providers, and other health care facilities or locations, and between health care facilities when the services are medically necessary and are provided by one or more ground ambulance vehicles designed for this purpose.
• Health care providers, including hospitals and air ambulance providers, can never require you to give up your protections from balance billing. If you have coverage through a self-funded group health plan, in some limited situations, a provider can ask you to consent to waive your balance billing protections, but you are never required to give your consent. Please contact your employer or health plan for more information.

Filing a Complaint

If you believe you’ve been wrongly billed, you may file a complaint with the federal government through the U.S. Department of Health and Human Services at www.cms.gov/nosurprises/consumers or by calling 800-985-3059; and/or file a complaint with the Washington State Office of the Insurance Commissioner at https://www.insurance.wa.gov/file-complaint-or-check-your-complaint-status or by calling 800-562-6900.

State Agency Contact Information

Washington State Office of the Insurance Commissioner

Phone: 800-985-3059
Website: www.insurance.wa.gov/protections-surprise-medical-billing

Additional Information

Visit the Office of the Insurance Commissioner Balance Billing Protection Act website at https://www.insurance.wa.gov/protections-surprise-medical-billing for more information about your rights under Washington state law.

Visit www.cms.gov/nosurprises/consumers or call 800-985-3059 for more information about your rights under federal law.