Deductible Credit for Out-of-Pocket Medical Expenses

The WSMA supports the introduction of future legislation in Washington state requiring health insurers to apply credit toward the enrollee’s deductible and out-of-pocket maximum for amounts paid directly to providers, if the following conditions are met:

1. The service is medically necessary and covered under the enrollee’s health plan;
2. The amount paid is less than the average in-network discounted rate for the same service or medication;
3. The enrollee uses a claim submission process as defined by the insurer or required by law 
(Res C-11, A-25)

The WSMA supports the introduction of future legislation in Washington state requiring insurers to create a clear, accessible, and standardized submission process, including forms and documentation requirements, for patients seeking deductible credit for out-of-pocket medical expenses. (Res C-11, A-25)

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Abbreviations for House of Delegates report origination:

EC – Executive Committee; BT – Board of Trustees; CPA – Council on Professional Affairs; JC – Judicial Council; CHS – Community and Health Services