Washington State Ambulance Rides May Cost Less Soon

Picture this: a medical emergency strikes, and the last thing you need to worry about is how much the ambulance ride to the hospital will cost. It’s a scary moment, and you want to focus on getting the help you need. Here’s the problem – ambulance rides can be extremely expensive, especially if the ambulance isn’t in your insurance network. Imagine getting hit with a hefty bill after a stressful situation. When it comes to ground ambulance rides, there may be good news on the horizon – lawmakers are looking into changing how ambulances charge people. The goal? Making sure you don’t get slammed with unexpected costs when you’re already dealing with a medical crisis.

The high cost of ambulance rides

The October report from the state Office of the Insurance Commissioner reveals that residents in Washington face high costs for ambulance rides, prompting state lawmakers and health officials to consider reforms, according to an article released by The Columbian. These include potentially prohibiting ambulance operators from billing consumers for insurance coverage gaps or establishing fixed reimbursement rates. The report brings up “balance billing,” where patients are charged the difference between insurance payments and total service costs. While a 2022 bill addressed surprise medical bills, it excluded ground ambulance services, leading to a study by the Insurance Commissioner’s Office.

What is the No Surprises Act?

The No Surprises Act, implemented in 2022, provides protections for individuals covered by group and individual health plans to prevent surprise medical bills. These protections cover most emergency services, non-emergency services (but NOT ground ambulance rides) from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. The Act establishes an independent dispute resolution process for payment disputes between plans and providers and introduces new dispute resolution opportunities for uninsured and self-pay individuals who receive medical bills substantially exceeding the initial good faith estimate provided by the provider. The Act aims to eliminate common types of surprise bills for those with private health insurance and allows individuals to request a good faith estimate of the care cost before receiving services. If there are disputes with the bill, individuals have options to contest the charges, providing them with enhanced rights and protections.

Surprise billing and balance billing

According to The Centers for Medicare and Medicaid Services, when the out-of-network provider bills “consumers for the difference between the charges the provider billed, and the amount paid by the consumer’s health plan” it is known as balance billing. “An unexpected balance bill is called a surprise bill.”

To put is more clearly:

  • Surprise Billing. Surprise billing occurs when you receive an unexpectedly high medical bill for services you did not anticipate would be out-of-network or not fully covered by your insurance.
    • You go to an in-network hospital for an emergency, but one of the doctors treating you is not in your insurance network. As a result, you receive a surprise bill for the out-of-network doctor’s services.
  • Balance Billing. Balance billing happens when a healthcare provider bills you for the difference between what your insurance covers and the total cost of the service.
    • You have surgery covered by your insurance, but the surgeon charges more than what your insurance considers reasonable. The surgeon bills you for the remaining amount not covered by your insurance, which is the balance bill.

When it comes to ambulance rides, surprise and balance billing still occurs.

Let’s explore a scenario:

You experience a medical emergency and require an ambulance to take you to the hospital. In your panicked state, you don’t have the opportunity to check whether the ambulance service provider is in your insurance network. The ambulance company that picks you up is not in your insurance network, but you assume that since it’s an emergency, your insurance will cover it. Later, you receive a bill for the ambulance services, and you’re surprised to find out that your insurance only covers a portion of the cost because the ambulance provider is out-of-network. The remaining balance, which is higher than you expected, becomes your responsibility to pay, leading to the surprise billing situation.

This scenario demonstrates how a medical emergency, where quick decisions are crucial, can result in a surprise bill if the ambulance service is not in your insurance network. It is not fair to the consumer, who should not have to take critical time while experiencing a medical emergency to determine which ambulances are in their network so they aren’t charged thousands of dollars later.

It is good news that Washington State appears to be looking into dealing with these balance bills for ambulance rides. Recommendations discussed by Washington State’s Office of the Insurance Commissioner include prohibiting balance billing for both emergency and non-emergency ambulance rides, requiring insurers to cover emergency transportation to specific facilities, and setting fixed rates for insurer reimbursement to ensure consistency among providers. The fixed rate recommendation is seen as crucial in addressing ambulance balance billing, but further study may be needed to implement changes effectively.

What can I do if I receive a balance bill for my ambulance ride?

Unfortunately, until further laws are passed that can assist in dealing with these bills, you will have to prepare to handle these bills on your own; however, there are some things you can do to possibly reduce these costs:

  • Ask questions. In emergencies, there may not be time to check if an ambulance is in your network. However, for non-emergencies, inquire with your insurer about in-network ambulance options.
  • CARES Act Protection. Healthcare providers who received funds from the federal Provider Relief Fund due to the CARES Act cannot balance bill for suspected or confirmed COVID-19 cases.
  • Ambulance service membership. Some ambulance organizations offer membership programs with an annual fee. Members are billed through insurance, but there are no out-of-pocket costs. Consider this if you have a condition requiring regular ambulance services.
  • Negotiate the bill. If stuck with an out-of-network bill, request your insurer to review the claim. Appeal if needed. Negotiate with the ambulance company for lower charges or a payment plan. Report issues to state regulators or the attorney general.

If you have been injured due to someone’s negligence, it is important to know that it is possible that you could have your ambulance bills paid through a personal injury lawsuit.

At Philbrook Law, we have handled all sorts of personal injury lawsuits, and know how to get you the compensation that you deserve, so that you do not end up paying thousands of dollars for treating your injuries. Our experienced legal team and attorneys are experienced and knowledgeable in both the Washington State legal system and Oregon’s legal system. To schedule a free consultation to discuss your options, call us in our offices at Battle Ground and Vancouver WA, or use our contact form. We also serve clients throughout Oregon.