Surprise billing – an issue that consumer advocates have been working to solve for years – happens when you get an unexpected, high medical bill from an out-of-network health care provider you didn’t know about. You couldn’t avoid it – you had a medical emergency and were powerless to control who treated you at the hospital. The problem stems from the fact that not all providers not have payment agreements with insurers, and consumers are caught in the middle. This is a major problem in our state and yet legislation failed to pass for the third consecutive year.

The surprise billing issue happens across the country. A recent lawsuit from Envision, an emergency room (ER) physician staffing firm, claims that UnitedHealthcare refuses to add Envision’s physicians to provider contracts. Meanwhile, UnitedHealthcare claims that Envision is charging patients ER rates three times higher than normal. Coordinated Care, with our state’s second highest Qualified Health Plan enrollment (54,516), recently paid a $100,000 fine to the Insurance Commissioner for failing to have enough providers in its network for anesthesiology, immunology, dermatology and rheumatology. Consumers end up paying the price.

A significant number of people in Washington experience surprise bills and medical debt. The Insurance Commissioner testified last year that his office had received 260 complaints about the issue, but that does not even represent the full scope of the problem. A survey of 13 individual and family market insurers and review of 1.7 million claims found 294,000 instances of balance billing – over 12,000 of them represented costs of over $1,500 to the consumer. It is especially problematic in emergency departments, laboratories, and for outpatient surgery. A recent national survey by the Pew Research Center found that about half of Americans say the cost of health care affects their household’s financial situation ‘a lot’ (53%).