A new law protects policyholders from out-of-network charges by Ground Ambulance Service Organizations (GASOs) and bans balance billing for covered emergency and non-emergency ground ambulance transportation. It applies 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.
Also, all health insurers must have a process that helps a provider, facility, or GASO determine if their patient is subject to Washington's law.
How patients are protected
If an enrollee is transported by an out-of-network GASO, it must bill the enrollee’s health plan directly. Any cost-sharing counts towards their deductible and is limited to what the enrollee would pay if the GASO was in their health plan’s network. Enrollees cannot be balance billed or asked to waive their balance billing protections.
Public database of ground ambulance rates
Local governmental entities that have established or contracted rates for ground ambulance services are required to submit them to a public database each year and update them annually by Nov. 1, if they have changed.
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 and the updated consumer notice (PDF, 205.78 KB) must be used. 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 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.
See translated consumer notices in 12 languages.
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.