1. (1) If claim costs are under the maximum benefit, the claimant should not pay any expenses relating to an allowed claim. Providers must bill the claimant's public or private insurance first, and then bill the department.

   EXCEPTION:

   A provider may require the claimant to pay for treatment if the claimant's eligibility is pending. If benefits are authorized, and payable by the department, the provider must refund the claimant in full.

2. (2) If claim costs exceed the maximum benefit, the claimant is responsible for expenses.

[Statutory Authority: Chapter 7.68 RCW. WSR 15-12-066, § 296-30-087, filed 5/29/15, effective 7/1/15; WSR 11-22-054, § 296-30-087, filed 10/31/11, effective 12/1/11.]