You have the right to:
(a) Receive services without regard to race, creed, national origin, religion, gender, sexual orientation, age or disability;
(b) Practice the religion of choice as long as the practice does not infringe on the rights and treatment of others or the treatment service. Individual participants have the right to refuse participation in any religious practice;
(c) Be reasonably accommodated in case of sensory or physical disability, limited ability to communicate, limited-English proficiency, and cultural differences;
(d) Be treated with respect, dignity and privacy, except that staff may conduct reasonable searches to detect and prevent possession or use of contraband on the premises or to address risk of harm to the individual or others. "Reasonable" is defined as minimally invasive searches to detect contraband or invasive searches only upon the initial intake process or if there is reasonable suspicion of possession of contraband or the presence of other risk that could be used to cause harm to self or others;
(e) Be free of any sexual harassment;
(f) Be free of exploitation, including physical and financial exploitation;
(g) Have all clinical and personal information treated in accord with state and federal confidentiality regulations;
(h) Participate in the development of your individual service plan and receive a copy of the plan if desired;
(i) Make a mental health advance directive consistent with chapter 71.32 RCW;
(j) Review your individual service record in the presence of the administrator or designee and be given an opportunity to request amendments or corrections; and
(k) Submit a report to the department when you feel the agency has violated your rights or a WAC requirement regulating behavioral health agencies.
(3) Each agency must ensure the applicable individual participant rights described in subsections (1) and (2) of this section are:
(a) Provided in writing to each individual on or before admission;
(b) Available in alternative formats for individuals who are visually impaired;
(c) Translated to the most commonly used languages in the agency's service area;
(d) Posted in public areas; and
(e) Available to any participant upon request.
(4) At the time of admission and upon client request, the agency must provide each client with information on how to file a report to the department if they feel their rights or requirements of this chapter have been violated.
Your Rights and Protections Against Surprise Medical Bills and Balance Billing
Washington State (effective thru December 31, 2024)
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay, and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-ofpocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
Insurers are required to tell you, via their websites or on request, which providers, hospitals, and facilities are in their networks. Hospitals, surgical facilities, and providers must tell you which provider networks they participate in on their website or on request.
You are protected from balance billing for:
Emergency Services
If you have an emergency medical condition, mental health or substance use disorder condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes care you receive in a hospital and in facilities that provide crisis services to people experiencing a mental health or substance use disorder emergency. You can’t be balance billed for these emergency services, including services you may get after you’re in stable condition.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most these providers may bill you is your plan’s innetwork cost-sharing amount.
You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When can you be asked to waive your protections from balance billing:
Health care providers, including hospitals and air ambulance providers, can never require you to give up your protections from balance billing.
If you have coverage through a self-funded group health plan, in some limited situations, a provider can ask you to consent to waive your balance billing protections, but you are never required to give your consent. Please contact your employer or health plan for more information.
When balance billing isn’t allowed, you also have the following protections:
• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
• Your health plan generally must:
o Cover emergency services without requiring you to get approval for services in advance (prior authorization).
o Cover emergency services by out-of-network providers.
o Base what you owe the provider or facility (cost-sharing) on what it would pay an innetwork provider or facility and show that amount in your explanation of benefits.
o Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may file a complaint with the federal government at https://www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059; and/or file a complaint with the Washington State Office of the Insurance Commissioner at their website or by calling 1-800-5626900.
Visit https://www.cms.gov/nosurprises for more information about your rights under federal law.
Visit the Office of the Insurance Commissioner Balance Billing Protection Act website for more information about your rights under Washington state law.
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119 N. Commercial St., Suite 1400
Bellingham WA 98225
(360) 734-0615
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