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Bill

SB 5395

Making improvements to transparency and accountability in the prior authorization determination process.

2025-2026 Regular Session Introduced by Bob Hasegawa and 5 co-sponsors

SB 5395 requires Washington insurers to increase transparency and accountability in prior authorization decisions, aiming to reduce treatment delays and improve patient access to approved medical care.

President signed.
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Bill Summary · SB 5395

Legislative bill overview

SB 5395 aims to improve transparency and accountability in Washington's prior authorization (PA) process—the system where insurance companies must approve certain medical treatments before they're provided. The bill establishes requirements for clearer disclosure of PA criteria, timelines, and decision-making processes to both patients and healthcare providers.

Why is this important

Prior authorization delays can prevent patients from accessing needed medical care while insurers review requests, sometimes creating dangerous gaps in treatment. By mandating transparency, the bill seeks to reduce denials based on unclear standards and give patients and doctors better ability to challenge unfair decisions. This directly affects healthcare quality and cost for Washington residents.

Potential points of contention

  • Insurance industry burden: Insurers may argue enhanced transparency requirements increase administrative costs, which could be passed to consumers through higher premiums
  • Speed vs. scrutiny tradeoff: Stricter timelines for PA decisions could pressure insurers to approve more requests without full review, potentially increasing healthcare costs overall
  • Definition clarity: The bill's success depends heavily on how "transparency" and "accountability" are specifically defined in final language—vague standards could be difficult to enforce

Compiled from official sources — confirm details with the bill’s official record.

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