S-547                 _______________________________________________

                                                   SENATE BILL NO. 3915

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State of Washington                              49th Legislature                              1985 Regular Session

By Senators Moore, Deccio, Wojahn, Sellar, Vognild and McManus

Read first time 2/8/85 and referred to Committee on Financial Institutions.

AN ACT Relating to a survey of reimbursement standards for commercial insurers and health care contractors; and creating new sections.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1.     It is the intent of the legislature that consumers should know the standards used by commercial insurers and health care service contractors to determine the amount of reimbursements for services provided by health care professionals.  Most insurers and health care service contractors base such reimbursements on "usual, customary, and reasonable" standards or some combination thereof.  However, there is no uniform definition of such standards and they are rarely described in a manner to allow the consumer any understanding of the basis for amounts paid by the insurer or health care service contractor.

NEW SECTION. Sec. 2.     The insurance commissioner is directed to conduct a survey of insurers subject to chapters 48.20 and 48.21 RCW and health care service contractors subject to chapter 48.44 RCW to obtain the following information:  (1) The definitions of "usual," "customary," and "reasonable" standards; (2) the methodology used to calculate benefits based on such standards, including the frequency of calculations; and (3) data comparing fees and charges reported to the carrier with fees and charges actually reimbursed using standards of usual, customary, and reasonable.  The commissioner shall report the findings, including recommendations for legislation, to the appropriate committees of the legislature on or before January 1, 1986.  Such recommendations shall include statutory definitions of "usual," "customary," and "reasonable" standards, methodology to be used when calculating benefits based on such standards, the frequency of such calculations, and any other matters the commissioner deems appropriate.