Washington Insurance Commissioner Mike Kreidler wants to take policyholders out of the euation when dispute arise over out-of-network coverage fees.
The Evergreen State’s top regulator this week proposed legislation that would end the so-called “surprise” medical bills for emergency care, which can charge patients thousands of dollars if that care is provided by a network not covered by the patient’s health insurance.
Instead, House Bill 2447 ensures that policyholders only pay expected charges – defined as copays and deductibles – for emergency care. If there is a problem regarding out-of-network fees, the problems will be worked out directly between the insurance carrier and hospital.
The hope is that the legislation ends situations encountered by patients like David Mouton of Seattle who, according to the Seattle Times, was charged more than $700 in out-of-network fees after he received emergency care for leukemia in 2012. Although the hospital was included in his health insurance network, the doctors in the ER were not.
In an emergency situation, he told the Times, “that is the farthest thing from your mind, plus you might not even be conscious to ask.”
Such incidents are not uncommon. According to the results of a survey Consumers Union, one in three Washington state residents with private insurance received a surprise medical bill in the past two years, in which their health plan paid less than expected.
Another 14% were charged an out-of-network rate when they thought their provider was in-network.
The proposal is expected to receive harsh opposition from the Washington State Medical Association, emergency-care doctors and others who say healthcare providers should “retain the right to bill for services provided,” a sentiment expressed by Dr. John Matheson of the American College of Emergency Physicians.
As for insurers, critics say they will have but two options when a patient receives a bill larger than expected: pay the fees or sent it to binding arbitration.
“We believe that the issue should be studied…before we rush into legislation that could unbalance this in either direction,” said Tacoma ER doctor Nathan Schlicher and president-elect of the WA-ACEP.
