Bill In Legislature to Ban Billing Patients For Ambulance Rides

A bill in the state legislature would eliminate the billing of patients for ambulance rides. 

Insurance companies are currently paying only a portion of the cost, forcing ambulance companies to bill patients for the balance of their costs. 

Washington Ambulance Association President Mike Battis says the bill establishes what the charges for ambulance rides will be and requires insurance companies to pay that cost. 

"If you're in an area that elected officials establish the ambulance rates, then that's what the insurance companies have to reimburse it as," said Battis. "If you're in an area that does not have locally established rates, then it defaults to 325% of Medicare." 

Battis is also Director of Operations at Ballard Ambulance in Wenatchee.  

He says the reimbursement rate of 325% of Medicare was established by the Office of the Insurance Commissioner (OIC) 

“They’re obligated to pay at that 325% rate, and we are also obligated to bill at that 325% rate, or less,” Battis said. “You know, if our bill is less than that, then it’s less than that.” 

In 2019, the state Legislature passed the Balance Billing Protection Act (BBPA), which prohibited the billing of the balance of a bill for emergency services to patients, but it did not include ground ambulance services.  

In 2020, Congress passed the federal No Surprises Act (NSA), which establishes federal protections against balance billing for emergency services, including air ambulance services, and certain other services provided at in-network facilities.  

In 2022, the Legislature amended the BBPA to align provisions with the NSA. 

Insurance companies have been able to cover only what they determine to be their responsibility of the cost of ground ambulance services as all ground ambulance companies are out of network. 

Battis said it's an unreasonable task to bring emergency services – ground ambulance services - into "in network" status with every insurance carrier’s plan in the state of Washington. 

The updated Balance Billing Protection Act required the , in collaboration with the Health Care Authority and Department of Health to submit a report and any recommendations to the appropriate legislative committees detailing how balance billing for ground ambulance services can be prevented and if ground ambulance services should be subject to the balance billing prohibitions. 

As part of its work, OIC convened an advisory group of stakeholders to work on the report. The stakeholders included fire departments, hospital districts, patient advocacy groups, labor groups, ground ambulance companies and insurance companies. 

In October 2023, OIC released its report, which included a prohibition on balance billing for emergency and non-emergency transports, and a requirement for the reimbursing of ground ambulance services at a local fixed rate or a fixed percentage of Medicare. 

There are two bills in the legislature as a result of that report, Senate bill 5986 and a concurrent House bill, 2285. 

The Senate bill was heard in the Health & Long Term Care Committee Friday. It's scheduled for a committee vote Tuesday. 

Insurance companies are in opposition to the rate of 325% of Medicare they would have to reimburse to ground ambulance companies.