Washington State's New Rules About Health Insurance Transparency

Despite criticism from both insurers and hospitals, Insurance Commissioner Mike Kreidler adopted a new rule Monday that spells out what health insurers must do to make sure their networks of hospitals and doctors can provide covered benefits to patients. “In the end, it’s my responsibility to make sure we protect consumers, and I have the tools to do it,” Kreidler said in an interview Friday. “If consumers start getting hurt, there’s nobody who is going to take the fall but me.”

Kreidler’s office published the rule Monday, and it will take effect May 26. The rule will apply to individual or small-group health plans in 2015 — essentially all state-regulated health plans offered inside or outside Washington Healthplanfinder, the state’s online insurance exchange.

For patients, the general thrust of the rule, which affects plans offered for coverage in 2015, is “no surprises.” It requires insurers to spell out how their benefit arrangements affect patients’ pocketbooks, clearly explain referral and authorization practices, tell policyholders whether emergency-room doctors in an in-network hospital’s emergency room are also in-network, and update directories of in-network providers monthly.