In 2024, the Washington legislature enacted a law protecting consumers from out-of-network charges by Ground Ambulance Service Organizations (GASO). The law takes effect January 1, 2025, and bans balance billing for covered emergency and non-emergency ground ambulance transportation. It was based on recommendations from a Ground Ambulance Advisory Group convened by the OIC.
Under the new law, If a nonparticipating (out-of-network) Ground Ambulance Service Organization (GASO) provides an ambulance transport to a health plan enrollee, they must bill the health plan directly and not the enrollee. The enrollee’s cost-sharing amount is limited to what it would be if the GASO was in the health plan’s network. Any cost-sharing paid by the consumer also counts towards their deductible. The GASO cannot balance bill the enrollee and cannot ask a consumer to waive their balance billing protections.
Also, local governmental entities that have established or contracted rates for ground ambulance services must submit their rates to the OIC by Oct. 16, 2024.
- Submit local GASO rates.
- Sign-up to get GASO-related news.
- OIC webinar GASOs and the Balance Billing Protection Act recording.
A public database of these rates is available.
Oct. 21 OIC carrier webinar GASOs and the Balance Billing Protection recording.
Oct. 22 OIC consumer webinar GASOs and the Balance Billing Protection recording.
Surprise billing protections under Washington’s Balance Billing Protection Act (BBPA) apply to all state-regulated health plans, state and school employee benefit plans and self-funded group health plans that opt in to Washington’s law. The federal No Surprises Act (NSA) does not prohibit balance billing for ground ambulance services, but effective January 1, 2025, Washington state law does. All health insurers must have a process that helps a provider, facility, or GASO determine if their enrollee is subject to Washington’s law.
Consumer notice requirements for ground ambulance service organizations
Effective January 1, 2025, ground ambulance service organizations (GASO) are included in the Balance Billing Protection Act. The updated consumer notice (PDF, 205.78 KB) must be used beginning January 1, 2025. For translated consumer notifications in twelve languages please visit the What consumers need to know about surprise billing webpage.
Medical providers, facilities, GASOs, and behavioral health emergency service providers must use the consumer notice to meet their obligations under WAC-284-43B-050, including posting the notice on their on their website and providing it to consumers, if asked. They also must:
- Refund consumers any amount they have overpaid within 30 business days.
- Not ask consumers to limit or give up their rights to prevent balance billing.
How enforcement works
If a GASO continues to balance bill a consumer and we see a pattern of unresolved violations of the Balance Billing Protection Act, we will first give the GASO a chance to correct its behavior. If no steps are taken to correct the balance billing, we will refer the GASO to the Department of Health for enforcement.