Washington state orders insurance carrier to reprocess ambulance service balance billing

Washington’s Office of the Insurance Commissioner has ordered a health insurance carrier and its subsidiaries to reprocess claims from more than 650 policyholders who were balance-billed by ambulance services for emergency ground transportation.

Washington has been debating whether to use the federal No Surprises Act as its main prevention of balance billing or to continue to rely on the state’s Balance Billing Protection Act. While both acts carve out exemptions for ambulance services, the Washington OIC news release noted the insurance carrier previously paid ambulance bills and only charged patients their typical deductible and cost-sharing.

In these cases, however, the carrier paid its pre-determined rate to the ambulance companies, billed consumers their contractual cost-sharing amount, and then the ambulance services billed the difference to consumers. In some cases, the ambulance companies sent unpaid patient bills to collections.

“Unfortunately, the insurer’s approach to this issue was not consistent with the law or the documents they have filed with our office. More importantly, it left consumers unfairly caught between the insurer and the providers,” Kreidler said.

He added that his office is in discussions with the insurer on how to best resolve the issue and make the impacted consumers whole.

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