Providers urge shorter clawback window; payers say 24‑month federal standard preserves reciprocal rights

Senate Bill 6,071 would standardize timelines for insurer overpayment recovery and shorten most refund/request windows to six months (and nine months for coordination of benefits) beginning in 2027. Committee staff summarized current law: carriers generally have 24 months to seek refunds, and last year the legislature shortened the window for mental‑health and substance‑use disorder services alone.

Leslie Emmerich (representing collective provider groups) and other small‑practice witnesses described clawbacks and retroactive reversals that arrive months or years later, disrupting cash flow and harming small businesses. Acupuncturists, massage therapists, podiatrists and speech‑language pathologists described administrative burdens and involuntary debt collections when insurers recoup payments long after services were provided.

Provider associations and the Washington State Medical Association supported a six‑month standard to create predictability. Payers, represented by Marissa Ingalls, argued the federal 24‑month standard exists to preserve reciprocal auditing and recovery rights, noting that eligibility changes, third‑party liability or other later discoveries can legitimately produce overpayments. Payers said more stakeholder negotiation is needed before expanding the shortened timeframe statewide.

What happens next: The committee heard competing views on fairness and administrative feasibility. Supporters emphasized predictable cash‑flow for small providers; payers warned of premature expansion without reciprocal processes for carriers.