Washington level funded, self-funded groups can opt-in to Balance Billing Protection Act
Washington Balance Billing Protection Act protects patients from surprise medical bills for emergency services and more.
In January 2020, Washington state established the Washington Balance Billing Protection Act (BBPA), which protects members enrolled in level funded and self-funded group plans from surprise medical bills when receiving care that meets certain criteria. Level funded and self-funded employer groups can now participate in and follow the BBPA.
Balance Billing Protection Act details
This surprise billing legislation establishes federal standards to protect patients from balance billing for defined items and services provided by specified doctors, hospitals and air ambulance carriers on an out-of-network basis. The legislation sets patient cost-sharing at in-network levels and requires providers to work with insurers and self-funded health plans to negotiate remaining bills. When insurers/health plans and providers are unable to reach an agreement, an Independent Dispute Resolution (IDR) process, sometimes called arbitration, is established to determine the final reimbursement amount.
The federal law applies to individual, small group, level funded and large group fully insured markets and self-funded group plans, including grandfathered plans.
Level funded and self-funded employer groups in Washington must complete the opt-in process on the state website to opt in. According to the state website, employer groups must opt in at least 30 days in advance of when their group intends to participate. Groups can opt in at the beginning of every year (January 1), at the time of a new business effective date or upon renewal. Groups may choose to manually renew on an annual basis or to be automatically renewed each year.
To see more information about the opt-in process for self-funded health plans, as well as a list of entities who have opted-in, click here.
No action is required for groups that do not want to participate in the BBPA
To align with the Federal No Surprises Act, the BBPA was updated in 2022 to include behavioral health emergency services in the definition of applicable emergency services. UnitedHealthcare will assist self-funded health plans when working with regulatory agencies for clarifications on regulations and to help reduce overall costs of care.
For more information, please contact your UnitedHealthcare representative.