New billing protections for ground ambulance patients take effect
December 31, 2024
OLYMPIA, Wash. — Washington state’s Balance Billing Protection Act has been expanded to include protections for patients who have been transported by a ground ambulance. The new law bans balance billing or “surprise billing” for covered emergency and non-emergency ground ambulance transportation.
If you are transported by an out-of-network ground ambulance provider, they must bill your health plan directly. Your cost-sharing amount is limited to what it would be if the ambulance was in your health plan’s network and the ambulance provider cannot balance bill you or ask you to waive your balance billing protections.
The Office of Insurance Commissioner (OIC) convened a Ground Ambulance Advisory workgroup that sent a report and recommendations to the legislature in 2023.
In addition to the new patient protections, local government entities that have set rates for ground ambulance services must submit these rates to a public database each year.
Under the new law, the amount an insurer must pay an out-of-network ambulance provider is based on the rates set by local jurisdictions that operate their own or contract for ground ambulance services. If no rate has been set, the provider is paid the lesser of 325% of what Medicare would pay or the ambulance provider’s billed charge.
A public database was created so health insurers would know how much to pay out of network ambulance providers. The current payment formula used for paying them expires on Dec. 31, 2027. During the fall in 2026, the OIC will report to the legislature on reimbursement trends it has seen since the new law took effect. The legislature will use that information to determine if the formula needs to be updated.
Washington is one of an estimated 15 states with similar protections for ground ambulance patients. The federal No Surprises Act does not include ground ambulance protections, but a federal advisory committee was created to send recommendations to congress.
Learn more about Washington’s Balance Billing Protection Act.
Legal Disclaimer:
EIN Presswire provides this news content "as is" without warranty of any kind. We do not accept any responsibility or liability for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this article. If you have any complaints or copyright issues related to this article, kindly contact the author above.
