Balance Billing Washington State: Protection and Resolution

In Washington State, balance billing is a serious issue that can leave patients with unexpected medical expenses. Balance billing occurs when an out-of-network provider charges a patient more than the in-network cost-sharing amount.

The state has implemented laws to protect patients from balance billing. For example, the Washington State Insurance Commissioner's office has rules in place that require health insurers to cover emergency services from out-of-network providers without prior authorization.

If you're facing a balance billing situation, you can file a complaint with the Washington State Insurance Commissioner's office. This can help resolve the issue and ensure that you're not left with a large medical bill.

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Balance billing, also known as surprise billing, occurs when an out-of-network provider bills the patient for the difference between the provider's charge and the insurance company's allowed amount.

This can happen unexpectedly, often during emergencies or when you're treated by an out-of-network provider at an in-network facility.

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Health plans are required to inform you, via their websites or on request, which providers, hospitals, and facilities are part of their networks.

Hospitals, surgical facilities, and providers must also tell you which provider networks they participate in on their website or on request.

The Balance Billing Protection Act (BBPA) in Washington state, implemented in 2020, offers protection from surprise medical bills. However, the Federal No Surprises Act (FNSA), which took effect in 2022, applies a broader scope of plans and services, offering even more transparency and disclosure for individuals seeking medical services.

Here are some key points to remember:

In Washington State, you have strong consumer protections against surprise medical bills. You're protected from balance billing for emergency services, including ground ambulance services, which were added in 2025.

If you get emergency care from an out-of-network provider, they can't bill you for more than your plan's in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, surgeons, and assistant surgeons, hospitalists, or intensivist services.

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You're also protected from balance billing for certain services at in-network hospitals or ambulatory surgical centers. Out-of-network providers at these facilities can't balance bill you, unless you give written consent and give up your protections.

Here's what you need to know about your rights and protections:

You're never required to give up your protections from balance billing. You can choose a provider or facility in your plan's network, and your health plan will pay out-of-network providers and facilities directly.

If you have any questions or concerns about balance billing, be sure to contact your health plan or the Washington Office of Insurance Commissioner (OIC) for assistance.

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If a provider or facility continues to balance bill a consumer in Washington State, the relevant authorities will give them a chance to correct their behavior before taking further action.

The authorities will first try to resolve the issue internally, but if no steps are taken to correct the balance billing, they will consider it unprofessional conduct and refer the provider or facility to the Department of Health for enforcement.

You can file a complaint with the Washington State Office of the Insurance Commissioner if you receive a medical bill that is substantially greater than your good faith estimate, which you can do within 120 days of the date of your bill.

If a provider or facility continues to balance bill a consumer, enforcement steps are taken to correct the behavior.

We will first give the provider or facility a chance to correct its behavior.

If no steps are taken by the provider or facility, we will consider it unprofessional conduct.

We will then refer the provider or facility to the Department of Health for enforcement.

The No Surprises Act has a built-in dispute resolution process for payment disputes between plans and providers. This process provides a fair way to resolve disagreements over medical bills.

If you receive a medical bill that's substantially higher than your good faith estimate, you can dispute it. You'll need to file your claim within 120 days of the bill date.

For services provided in 2022, you can dispute a medical bill if your final charges are at least $400 higher than your good faith estimate. This is a specific rule to keep in mind when reviewing your medical bills.

You can file a complaint with the Washington State Office of the Insurance Commissioner if you need help resolving a dispute. You can also call them at 1-800-562-6900 for assistance.

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You're protected from surprise medical bills or balance billing if you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center.

As of January 1, 2022, you have federal rights and protections against surprise medical bills under the No Surprises Act.

You may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible, when you see a doctor or other healthcare provider.

You may also have to pay the entire bill if you see a provider or visit a healthcare facility that isn’t in your health plan’s network.

The Washington Balance Billing Act, effective January 1, 2020, protects members of individual and family plans—as well as some group plans—in Washington from surprise medical bills or balance billing.

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