Washington lawmakers look at shielding people from surprise ambulance costs

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People in Washington often face high costs for ambulance rides, despite not having a choice about the service, an October state Office of the Insurance Commissioner report found.

State lawmakers and health officials are now looking at ways to change that, including by prohibiting ambulance operators from billing consumers for costs their insurance doesn’t cover or by setting fixed reimbursement rates for service.

“I fully expect this will be a focus in the upcoming session,” Sen. Annette Cleveland, D-Vancouver, told the Senate Health and Long Term Care Committee on Thursday.

The committee, which Cleveland chairs, received a briefing on the Office of the Insurance Commissioner study. The report looks at “balance billing” for ambulance services in Washington. Balance billing is when a company charges the patient the difference between what their insurance paid and the total cost of services.

In 2022, lawmakers passed a bill to strengthen protections for consumers against surprise medical bills, including for most emergency services and air ambulance trips.

While the legislation did not address surprise billing for ground ambulance services, it did require the Insurance Commissioner’s Office to study balance billing and to recommend related policy changes.

The study found that ground ambulances are the only emergency service for which consumers are at risk for balance billing. On average, the part of the ambulance bill patients were responsible for was more than $500 for emergency trips and more than $1,000 for non-emergency service.

Ambulance operators said they often use balance billing to cover the gap between the cost of their services and payments they receive from the state’s Medicaid program and Medicare. Emergency medical service providers, the report notes, rely on multiple sources of funding, including health insurance payments, Medicare and Medicaid, and local government funding.

The report also found that there are 404 public, 68 private and six tribal ambulance agencies in Washington, but their size and structure can dictate which health plans they contract with and how they bill.

“There are a lot of EMS organizations in the state of Washington, and they vary immensely,” said Jane Beyer, senior health policy advisor at the Office of the Insurance Commissioner.

Policy recommendations

One recommendation from the report is to entirely prohibit balance billing for emergency and non-emergency ambulance rides.

Although non-emergency transports made up less than 20% of claims that the study looked at, non-emergency services often have a higher cost for passengers, said Simon Casson, data and economic analyst at the Office of the Insurance Commissioner.

Beyer said it is important that policy changes apply to both emergency and non-emergency services because even in non-emergency situations, patients or family members often don’t have a choice in which ambulance provider they can use.

The report also recommends that the state require insurers to cover emergency transportation to sites such as behavioral health facilities or crisis stabilization providers.

Another recommendation is to set a fixed rate for how much insurers reimburse both private and public ambulance providers for emergency transports.

Because providers and how they bill vary so drastically in Washington, Beyer said setting the rate that providers get reimbursed could help ensure that they are reimbursed at the same rate and make the costs they pass on to consumers more predictable.

She added that she anticipates the fixed rate recommendation will be key in addressing ambulance balance billing next session, though it will likely be complex and could need further studying before changes are made.

by Laurel Demkovich, Washington State Standard

Washington State Standard is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Washington State Standard maintains editorial independence. Contact Editor Bill Lucia for questions: info@washingtonstatestandard.com. Follow Washington State Standard on Facebook and Twitter.

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