Washington Insurance commissioner Mike Kreidler is hopeful a measure dealing with out of network expenses for medical insurance will be approved by the Washington state legislature by Friday.
The bill would help deal with what’s not an uncommon occurrence. a patient has surgery that's performed in an in-network facility by an in-network physician, but involves specialists or other providers who are out-of network.
Kreidler says HB 2114 would address the problem by making out-of-network providers and insurance carriers negotiate a price and keep the patient out of it.
“It specifies a formula where it says the average rate paid to this particular type of provider in this type of situation. We have an all-payer database, we take a look at the database, we find out what the average compensation is reimbursement for that particular procedure , the provider gets that when it’s in one of these out of network situations, it’s no fault of the policy holder,” says Kreidler.
Opponents, including the Washington State Medical Association, say it will allow insurance companies to force out-of-network fees so far below the current rates, that many hospitals won't be able to attract and retain the best qualified doctors.