CAP Applauds New State Law to Stop Surprise Medical Bills

  • 21-MAY-2020

  • WASHINGTON, DC

Washington — The College of American Pathologists (CAP) commended officials in the state of Washington for enacting law to protect patients from surprise out-of-network medical bills by banning balance billing for certain out-of-network services and requiring health insurance plans to maintain adequate networks of physicians at in-network hospitals and facilities. 

Washington Gov. Jay Inslee signed the bill into law on May 21. State law now requires regulators to determine whether the insurance carrier’s provider network has a sufficient number of contracted physicians, including emergency, surgical, and other specialty physicians such as pathologists. The patient protections enacted by the state will apply to health plans regulated by the Washington Commissioner of Insurance.

“Health plans with inadequate networks are the root cause of surprise bills,” said CAP President R. Bruce Williams, MD, FCAP. “For years, insurance companies have narrowed networks and we have seen the impact on our patients receiving surprise medical bills. By setting network adequacy standards, the state of Washington will ensure access to lifesaving medical care and reduce instances of out-of-network bills. We encourage Congress to pass similar legislation to ensure patient access and take necessary steps toward protecting all Americans from surprise bills.”

Physicians, patients, and other health professionals support ensuring health insurance plans maintain adequate provider networks. In a public national declaration on health plan network adequacy, pathologists, radiologists, and hospitalists, in addition to 11 patient advocacy groups all urged state and federal lawmakers to require health plans be subject to the requirement.

After Louisiana and New Hampshire, Washington is now the third state requiring health plan network adequacy for hospital-based physician specialists. Other key highlights of the new Washington law include:

  • A statutory reimbursement rate or mechanism for out-of-network reimbursement requiring payment to be set at a commercially reasonable rate.
  • A dispute resolution process.
  • Direct payment from carriers to physicians, which prohibits carriers from routing payment through patients.
  • Requirements pertaining to transparency and enforcement of the law.

About the College of American Pathologists

As the world's largest organization of board-certified pathologists and leading provider of laboratory accreditation and proficiency testing programs, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. For more information, visit yourpathologist.org to watch pathologists at work and see the stories of the patients who trust them with their care. Read the 2018 CAP Annual Report at CAP.ORG.