A recent bill in the Washington state legislature aims to address the issue of patient billing for ambulance rides, proposing significant changes to the current system.
Currently, insurance companies cover only a portion of ambulance costs, leaving patients responsible for the remaining balance. This has led to challenges for ambulance companies in billing patients appropriately.
PROPOSED CHANGES:
The bill, supported by Washington Ambulance Association President Mike Battis, seeks to establish fixed charges for ambulance rides. It mandates insurance companies to pay these established costs, either determined by local officials or defaulted to 325% of Medicare in areas without established rates.
In 2019, the Balance Billing Protection Act (BBPA) was passed, preventing balance billing for emergency services but excluding ground ambulance services. The federal No Surprises Act (NSA) in 2020 provided further protections. In 2022, the BBPA was amended to align with the NSA, prompting a review of ground ambulance billing.
WHAT HAPPENS NOW:
The Office of the Insurance Commissioner (OIC) released a report in October 2023, proposing a prohibition on balance billing for emergency and non-emergency ambulance transports. The report also recommended reimbursement for ground ambulance services at a local fixed rate or a fixed percentage of Medicare.
Two bills, Senate Bill 5986 and House Bill 2285, were introduced in response to the OIC report. Senate Bill 5986 has undergone committee hearings and is scheduled for a vote. The bills aim to implement the OIC recommendations into law.
INSURANCE INDUSTRY OPPOSITION:
Insurance companies oppose the proposed 325% of Medicare reimbursement rate for ground ambulance services. This opposition creates a point of contention in the ongoing legislative discussions.
CONCLUSION:
The proposed bills signal a significant step toward reforming ambulance billing practices in Washington state, addressing the challenges faced by both ambulance companies and patients. The debate over reimbursement rates highlights the complexity of finding a balanced solution that benefits all stakeholders.