Disclaimer: This article is for informational purposes only and does not constitute legal advice. Always consult a qualified attorney for advice on your specific situation.
Detailed Answer
Washington does not have a “Rule 414” equivalent to North Carolina’s administrative billing rule. Instead, Washington law requires insurers to pay the reasonable value of necessary medical care following an auto accident or other covered injury. Key provisions include:
- RCW 48.22.030 – No limit on amount payable. Insurers must pay the reasonable value of services and materials necessarily furnished to the injured person. Read the statute.
- RCW 48.22.085 – Provider liens. Medical providers may file a lien to secure payment. Read the statute.
- WAC 284-30-310 – Claims handling standards. Insurers must investigate and process claims promptly and cannot unilaterally reduce bills based on rules from other states. Read the regulation.
In practice, an insurance adjuster in Washington may negotiate medical bills to reflect usual and customary charges in the local market. They often request itemized statements and may challenge inflated or duplicative charges. However, they cannot invoke a non-existent “Rule 414” to force a reduction. Providers who dispute an insurer’s offer can enforce their lien rights or negotiate settlement directly.
How Insurers May Challenge Bills
An adjuster may:
- Compare charges against local average rates.
- Request medical records to confirm treatment necessity.
- Use independent bill review services.
- Negotiate discounts with the provider.
When to Seek Legal Help
If your insurer refuses to pay the reasonable value of your medical bills or improperly delays payment, consider consulting an attorney experienced in insurance claims. An attorney can help enforce lien rights, negotiate fair settlements, or file an insurance bad faith claim under RCW 48.30.015.
Helpful Hints
- Keep all medical invoices and records organized.
- Obtain a detailed explanation of benefits (EOB) from your insurer.
- Know your provider’s lien filing deadlines under RCW 48.22.085.
- Ask for a written breakdown of any reductions to your bills.
- Consider independent bill review if negotiations stall.