Balance Billing Laws in Washington
Your medical billing rights and protections in Washington.
Washington enacted the Balance Billing Protection Act (SB 5526, 2019) as part of its broader healthcare consumer protection framework. The law prohibits balance billing for emergency services and for non-emergency services at in-network facilities. Washington has been a national leader in health insurance consumer protection and network adequacy requirements.
Key Protections in Washington
Emergency services: Washington law prohibits balance billing for emergency services; cost-sharing limited to in-network amounts
Non-emergency care at in-network facilities: Patients protected from balance billing by out-of-network providers when they had no choice of provider
Dispute resolution: Washington Insurance Commissioner oversees a state dispute resolution process with binding arbitration
Network adequacy: Washington has strong network adequacy standards to reduce the likelihood of involuntary out-of-network care
Filing Information
Within 3 years of the date of service for state-level complaints
Additional Notes
Washington's Balance Billing Protection Act is part of a comprehensive consumer protection framework. The state also administers the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) with additional consumer protections. Self-funded plans fall under federal jurisdiction.
How to File a Complaint in Washington
Gather Your Documentation
Collect your itemized medical bill, Explanation of Benefits (EOB) from your insurer, any prior authorization documents, and written communications with the provider or insurance company.
File with the State Regulator
Submit your complaint to the Washington Office of the Insurance Commissioner. Include all supporting documents and a clear description of the billing dispute.
File complaint with Washington Office of the Insurance CommissionerFile with CMS if Federal Protections Apply
If your dispute involves the No Surprises Act (emergency care or out-of-network providers at in-network facilities), you can also file directly with the Centers for Medicare & Medicaid Services.
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