Revised Code of Washington

Wash. Rev. Code § 48.43.055 (2026)

✓ current as of May 2026

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(1) Except as provided by subsection (2) of this section, each health carrier as defined under RCW 48.43.005 shall file with the commissioner its procedures for review and adjudication of complaints initiated by health care providers. Procedures filed under this section shall provide a fair review for consideration of complaints. Every health carrier shall provide reasonable means allowing any health care provider aggrieved by actions of the health carrier to be heard after submitting a written request for review. If the health carrier fails to grant or reject a request within thirty days after it is made, the complaining health care provider may proceed as if the complaint had been rejected. A complaint that has been rejected by the health carrier may be submitted to nonbinding mediation. Mediation shall be conducted under chapter 7.07 RCW, or any other rules of mediation agreed to by the parties. This section is solely for resolution of provider complaints. Complaints by, or on behalf of, a covered person are subject to the grievance processes in RCW 48.43.530.

(2) For purposes of out-of-network payment disputes between a health carrier and health care provider covered under the provisions of chapter 48.49 RCW, the arbitration provisions of chapter 48.49 RCW apply.

[ 2019 c 427 s 28; 2005 c 172 s 19; 2002 c 300 s 6; 1995 c 265 s 20.]

Notes:

Findings—Intent—Effective date—2019 c 427: See RCW 48.49.003 and 48.49.900.

Short title—Effective date—2005 c 172: See RCW 7.07.900 and 7.07.904.

Captions not law—Effective dates—Savings—Severability—1995 c 265: See notes following RCW 70.47.015.

Notes of Decisions

Cited in 7 cases, 2004–2013 · leading case: Kruger Clinic Orthopaedics, LLC. v. Regence Blueshield, 138 P.3d 936 (Wash. 2006).

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Kruger Clinic Orthopaedics, LLC. v. Regence Blueshield, 138 P.3d 936 (Wash. 2006). · cites it 19× “§ 2 , does not preempt RCW 48.43.055 and WAC 284-43-322(4), which prohibit health insurance carriers from requiring providers to engage in "alternative dispute resolution to the exclusion of judicial remedies.”

Dep't of Transp. v. James River Ins., 292 P.3d 118 (Wash. 2013). · cites it 4× “3 In that case, we were considering whether RCW 48.43.055 and WAC 284-43-322 prohibited binding arbitration agreements in contracts between insurers and health care providers.”

Jolley v. BlueShield, 153 Wash. App. 434 (Wash. Ct. App. 2009). · cites it 8× “¶5 In 2000, the parties amended the practitioner agreement to satisfy WAC 284-43-322, which provided that no process for dispute resolution arising out of a participating provider contract will be fair under RCW 48.43.055 unless it includes a formal process for dispute…”

Jolley v. Blueshield, 220 P.3d 1264 (Wash. Ct. App. 2009). · cites it 9× “¶ 5 In 2000, the parties amended the practitioner agreement to satisfy WAC 284-43-322, which provided that no process for dispute resolution arising out of a participating provider contract will be fair under RCW 48.43.055 unless it includes a formal process for dispute…”

Kruger Clinic Orthopaedics, L.L.C. v. Regence BlueShield, 123 Wash. App. 355 (Wash. Ct. App. 2004). · cites it 2× “Specifically, the regulation states: Except as otherwise required by a specific federal or state statute or regulation governing dispute resolution, no process for the resolution of disputes arising out of a participating provider or facility contract shall be considered fair…”

Kruger Clinic Orthopaedics, LLC v. Regence Blueshield, 98 P.3d 66 (Wash. Ct. App. 2004). · cites it 2× “Specifically, the regulation states: Except as otherwise required by a specific federal or state statute or regulation governing dispute resolution, no process for the resolution of disputes arising out of a participating provider or facility contract shall be considered fair…”

Kruger Clinic Orthopaedics, L.L.C. v. Regence BlueShield, 157 Wash. 2d 290 (Wash. 2006). · cites it 19× “§ 2 , does not preempt RCW 48.43.055 and WAC 284-43-322(4), which prohibit health insurance carriers from requiring providers to engage in “alternative dispute resolution to the exclusion of judicial remedies.”

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