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  • Jesse Arnoldson

Are You Paying Attention to Local Legislation?


Recently in Idaho and Washington, legislation has come forward to prevent patients from being balanced billed by out-of-network providers and other service lines such as ambulance companies and laboratories. The Idaho bill specifically would have limited out-of-network payments to the greater of 85% contracted in-network rate or 145% of Medicare.

It’s not too crazy of an idea to try and provide patients with some sort of protection in scenarios where there really is not a choice in the matter (i.e. emergency ambulance rides, back-room radiology readings, etc.) However, these bills are applying the same rules to ambulatory practices and shifting costs from the insurance company over to the provider. It seems absolutely unfair that the reimbursement could end up being less than contracted in-network rates, making it less likely to see payers negotiate with private practices.

This last week we saw the Idaho bill die in committee and while this is an Idaho and Washington situation, it seems that other states are getting the same idea. If it became illegal to balance bill patients for out-of-network care how would that affect the practice you manage? Would it make it more difficult to negotiate with payers? You can learn more about both bills here, IDAHO and WASHINGTON.