Medical Debt, Surprise Billing, and Charity Care Law in Washington State
**Changes to charity care laws are here! 2022 HB 1616 went into effect on July 1, 2022. Find more information here.**
Every day someone receives a staggering medical bill for anything from a doctor’s consultation to major surgery. According to the US Census Bureau, “The SIPP [Survey of Income and Program Participation] shows that in 2017, 19% of U.S. households carried medical debt, defined as medical costs people were unable to pay up front or when they received care. Among households with medical debt, the median amount owed was $2,000, meaning half had more and half had less.” Even with health insurance, deductibles and co-pays can add up and become overwhelming.
Medical Debt Collection
According to the Washington State Legislature, “The 2015 Washington Civil Legal Needs Study Update found that seven in 10 low-income households face at least one civil legal problem each year. The most common problem faced by these households involves health care.” In 2019 the Legislature passed updates to the law regarding the collection of medical debt. The Washington State Hospital Association explains, “SHB 1602 addresses consumer debt generally and changes requirements for post-judgement interest and garnishment. SHB 1531 addresses medical debt more specifically and changes requirements for pre-judgement interest, information collection agencies must provide to debtors, and when a medical debt can be assigned or sold to a collection agency.”
Surprise Billing
In addition to enacting changes to medical debt collection laws, the 2019 legislature also passed legislation prohibiting surprise billing, also known as “balance billing,” by out-of-network providers performing emergency services or surgical or ancillary services at an in-network hospital or surgical center. Prior to the passage of this legislation, consumers often found themselves dealing with unexpected medical expenses and fighting with providers and insurance carriers. Information about Washington’s surprise billing law and its application is available at the Office of the Insurance Commissioner’s website.
More recently, Congress passed bipartisan federal surprise billing legislation. Administrative rulemaking implementing the legislation began just this month. The regulations will go into effect January 1, 2022. The New York Times reports that “[s]ome experts see the policy as the most important consumer protection in health care to come out of Washington in more than a decade.” As of February 2021, only 33 states had some surprise billing protections, so the new laws will be welcome to many United States consumers.
Charity Care
Many people face a difficult choice when they need to see a doctor, as they may not have insurance or the ability to pay for medical services. However, since 1989 Washington law has prohibited hospitals from denying care to patients based on the inability to pay. The Washington State Department of Health’s Hospital Patient Information and Charity Care website states, “RCW 70.170 and WAC 246–453 require hospitals to develop charity care policies, procedures and sliding fee schedules to ensure that all patients with family incomes below 100% of the federal poverty guidelines are able [to] obtain medically necessary hospital health care free of charge, and patients with family incomes up to 200% of the federal poverty guidelines are able to obtain that care at a discount. Charity care may also be called financial assistance, bridge assistance, or other names.” The Department of Health provides a list of charity care policies for hospitals around the state as well as a complaint process for patients if they feel their hospital has not followed charity care policies.
Medical bills, health care costs, and debt collection laws can be very confusing and make an already stressful situation even more so. Legal assistance organizations such as Washington Law Help have created guides and videos for navigating the process and for understanding your rights when faced with medical debt and the need for charity care. The Washington Law Help tutorials include:
Getting Help with Medical Debt in Washington State
Can I get Charity Care Benefits to Pay for My Hospital Bill?
Help with Medical Bills for Immigrants without Legal Immigration Status
The Washington State Law Library also holds books on Washington debt collection practice and law, along with charity care. These and other health care law titles can be found in the law library catalog.
Additional Links and Resources:
Charity Care in Washington — April 2021 Report to the Legislature (Washington State Department of Health)
Charity Care and Financial Assistance at Washington State Hospitals (Washington State Hospital Association)
No Surprises Act (Centers for Medicare & Medicaid Services)
Seeking Financial Assistance For Your Medical Bills (Nolo.com) (LE)
