Lawmakers Pass Bill To Eliminate Ambulance Costs For Patients

Patients in Washington state will no longer be stuck with surprise ambulance bills after lawmakers in Olympia passed a measure to eliminate those fees. 

The legislation requires insurance companies to cover the ambulance bills regardless of network status at a now-regulated rate.

Washington Ambulance Association President Mike Battis says a lack of insurance coverage has forced ambulance companies to bill patients for their costs.  

"They thought that they had a great plan, good coverage, and then all of a sudden they get this balance bill because the insurance carrier said, 'No, we're only going to pay $400 of that $1,200 ambulance bill,'" said Battis. "So, then the patient would get stuck with $800 of the balance." 

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

The bill will be sent to Governor Inslee after a conference committee reconciles slight differences between what was passed in the House and Senate. 

The House added an amendment, that will make the rate insurance providers pay to ambulance companies subject to change. 

"They're going to put a sunset on it, so in two years, the rate will have to be renegotiated," Battis said. "It just gives everybody the opportunity to, kind of, see where it's at, make sure that the bill is doing what it's intended to do, and make sure that those rates aren't too high, or they aren't too low." 

If the bill is signed by Governor Inslee, as expected, then patients will not get any ambulance bills after the first of next year. A notable exception would be if an insurance policy had a specific carveout requiring patients to cover ambulance costs.

The reimbursement rate has been set at 325% of what Medicare pays for the same ambulance services. The rate was set by the state Office of the Insurance Commissioner (OIC).  

 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.  

During that entire time, 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 OIC, 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 reimbursement of ground ambulance services at a local fixed rate or a fixed percentage of Medicare. 

OIC then set the rate at 325 percent of Medicare. 

The bill in the legislature, SB 5986, passed the Senate unanimously, 48-0, and was approved overwhelmingly in the House, 95-1.