Full text of Washington Revised Code of Washington § 48.46.243 — Contract — Participant liability., with citation guidance and answers to common questions.
§ 48.46.243. Contract — Participant liability.
(1) Subject to subsection (2) of this section, every contract between a health maintenance organization and its participating providers of health care services shall be in writing and shall set forth that in the event the health maintenance organization fails to pay for health care services as set forth in the agreement, the enrolled participant shall not be liable to the provider for any sums owed by the health maintenance organization. Every such contract shall provide that this requirement shall survive termination of the contract.
(2) The provisions of subsection (1) of this section shall not apply:
(a) To emergency care from a provider who is not a participating provider;
(b) To out-of-area services;
(c) To the delivery of covered pediatric oral services that are substantially equal to the essential health benefits benchmark plan; or
(d) In exceptional situations approved in advance by the commissioner, if the health maintenance organization is unable to negotiate reasonable and cost-effective participating provider contracts.
(3) No participating provider, or insurance producer, trustee, or assignee thereof, may maintain an action against an enrolled participant to collect sums owed by the health maintenance organization.
Notes
Intent—2016 c 122: "It is the intent of the legislature to allow certain provider compensation exhibits to remain confidential by making permanent the provisions of chapter 277, Laws of 2013, which currently expire July 1, 2017, thereby maintaining efficient review and approval of health care plans by the insurance commissioner and fostering innovation in the Washington health insurance market." [
2016 c 122 s 1.]
Severability—Effective date—2008 c 217: See notes following RCW
48.03.020.
Frequently Asked Questions About Washington § 48.46.243
What does Revised Code of Washington § 48.46.243 cover?
Section 48.46.243 ("Contract — Participant liability.") is part of the Revised Code of Washington, the codified statutory law of Washington. It sets out the legal rule or procedure described in the text above. Statutes are amended regularly, so always verify against the official source.
How do I cite Washington § 48.46.243?
A common citation format is "Revised Code of Washington § 48.46.243" (Washington). Legal writing may require the code abbreviation, section number, and year or edition. Match the style required by your court, professor, or publisher.
Is this the official text of Washington law?
No. This page is for research and education and may not include the most recent amendments. For official current law, check the Washington official source linked on this page or consult a licensed Washington attorney.
How does Washington § 48.46.243 apply to my situation?
Statutes are interpreted in context, and application depends on your specific facts. Only a licensed attorney in Washington can advise on how this section applies to you. Contact your state or local bar association for a referral.
Sources & Verification
Not legal advice. Verify against the official source and consult a licensed attorney in Washington.
