Health insurance consumers in Washington State are up in arms over their unusually large medical bills.
The cause for the increased medical costs? An industry practice known as balance billing—something state lawmakers want to address in order to better protect the interests of consumers.
Balance billing occurs when medical care providers and insurers fail to settle over which treatments and medical services get covered. Medical providers will then send patients the remaining part of their medical costs that their insurers will not cover. Once a provider does this, the patient’s insurer deems the provider “out of network.”
The business practice is currently legal in Washington, but there have been attempts to create new legislation that protects consumers from balance billing.
During the past legislative session, Washington State insurance commissioner Mike Kreidler proposed HB2447, which would have required insurers and healthcare providers to settle disputes over out-of-network fees through arbitration.
"Consumers cannot be treated this way," the commissioner said. "The consumer is playing by the rules. They shouldn't be penalized."
Kreidler’s proposal, however, failed to gain any traction after it was strongly opposed by both healthcare providers and insurers. Both groups worry that the bill would lead to costly arbitrating bill disagreements that are ultimately passed down to consumers in the form of higher healthcare prices.
"That is an onerous administrative burden and would increase the cost of healthcare for everyone," remarked Premera Senior VP of Healthcare Delivery Systems Beth Johnson.
"Why do we want to make systems that just cost the consumers money?" Washington State Medical Association Assistant Secretary-Treasurer Dr. Nathan Schlicher asked in response to the bill’s proposal.
Both groups have also realized that the core of the issue is a dispute over prices between them.
"If I'm legally required to take care of you, what incentive does the other side have, AKA the insurance company, have to negotiate?" said Schlicher.
"We need to make sure we are keeping healthcare affordable. So, we do our best to stay within a range for reimbursement," Johnson asserted.
According to KING 5 News, negotiations are currently underway for a new measure that protects consumers from balance billing for next year; it is hoped that the new bill would receive approval from both insurers and healthcare providers.
