Balance billing interpretations focus of legal battle

A balance billing dilemma in Washington state has doctors and insurers going head-to-head in court over whom ultimately is responsible for paying physicians for emergency room care, reports the Seattle Times. Doctors are insisting that insurers should pay them, regardless of whether or not they are affiliated with an insurance carrier accepted by the hospital at which they are working, in accordance with statute RCW 48.43.093

"During an emergency, the last thing a patient should have to do is call their health insurer to find out if the physicians treating them are part of their insurer's network," Dr. Dean Martz, president of the Washington State Medical Association, said in a statement. "When a patient shows up in the emergency department needing care, time is of the essence. Expecting patients or their families to go through such a process is ridiculous." 

However, Beth Berendt, the state's deputy insurance commissioner, believes that insurers already are in compliance with the 1997 law. Berendt and insurance commissioner Mike Kreidler agree with insurers who challenged the interpretation that payers are responsible for all emergency services costs, sans co-payments, coinsurance and deductibles. 

"We really do believe that patients may be held hostage in this situation, and it's very unfortunate," Berendt told the Times. But "we believe the law is clear, and we believe our carriers are administering it appropriately." 

State representative Eileen Cody, D-West Seattle, who is sick of seeing patients get burned, currently is working on legislation to try to please both doctors and insurers. 

"I kept telling them: 'I don't care about you guys. You both agree that this is a fight between doctors and the [insurance] carriers, but who gets the brunt is the patient,'" Cody said, according to the Times. "What I'm trying to do is eliminate balance billing." 

For more information:
- read the Seattle Times article
- check out this press release from the Washington State Medical Association
- read through statute RCW 48.43.093