Consumers

The law 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. 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. 

• See the public database of locally set rates
• Submit local GASO rates 

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 205.78KB) 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. 

This rule applies to auto and home insurance, including manufactured home, condominium and renters insurance. 

What consumers can do

If your premium increases when your policy renews, you can ask your insurance company why. To do so, send them a message using the contact information on your renewal notice or billing statement.

Make sure the message includes your name, policy number and the renewal date of your policy. For example, you could write:

• “My name is Jack Q. Policyholder and my auto insurance premiums went up. My policy number is 654321 and my renewal date is June 2, 2024. Please mail me an explanation for why my premiums went up.”

What insurance companies have to do

When a policy renews and the premium increases, the policyholder can ask you why. If they do, you need to give them a reasonable explanation using terms they can understand.

You also need to include a disclaimer on renewal notices or renewal billing statements. It should use at least 12-point bold font and have language similar to:

• "If your premiums increased when your policy renewed, you can ask for an explanation by contacting us in writing. See Chapter 284-30A WAC for more information on your right to an explanation for your rate increase."

The disclaimer also needs to include your company’s contact information.

Changes coming in 2027

Starting June 1, 2027, if your premium increases by 10% or more when your policy renews, your insurance company needs to tell you why. They also need to provide this explanation if you ask for it.

Your insurer will send you a written notice explaining the main reasons for the increase, which may include:

• Location of the vehicle
• Driving record
• Miles you've driven
• Number of drivers
• Number of vehicles
• Claims you've filed
• Discounts
• Fees and surcharges
• Age
• Credit history
• Education
• Gender
• Marital status
• Occupation
• Property age, location and value

They may also include other reasons.

When to submit this form?

• No later than three business days after the date of the settlement agreement.
• The form must be submitted even if an initiating party’s arbitration initiation request form (AIRF) is under review by the OIC, an AIRF number has not yet been assigned, and or an arbitrator has not yet been assigned.

How to complete and submit this form

1. After carefully reading and following the instructions on this page, download the settlement reporting form (PDF, 255.84 KB).
2. Fill in all required information (i.e., initiating party information, dispute resolution information, etc.). If there is no AIRF number (OIC tracking number) note, “not assigned yet.”
3. Complete the form, which must be signed by both parties.
4. File electronically by uploading the form as a .PDF attachment to the contact the arbitration team form.

To submit a settlement reporting form for more than one arbitration proceeding involving the same parties

Parties may submit a spreadsheet containing all the required information for each claim that has been settled, as follows:

• The initiating party’s information and the parties' signatures must be indicated on the form; signatures may be electronic. The rest of the fields may say “see attached”
• The spreadsheet columns should match the form fields on the settlement reporting form (i.e., date of settlement, OIC tracking number, name of carrier, etc.)
• The spreadsheet and form should be saved to a single .PDF signed by the parties electronically.

For each arbitration proceeding they oversee, the arbitrator must submit to our office:

1. The applicable reporting form; and
2. Their written decision

Reporting forms (Appendix B or Appendix C)

There are two arbitrator decision reporting forms, referred to as Appendix B and Appendix C. A brief description is provided below to assist you in determining which form is the appropriate one to use.

Once you have determined the appropriate form, there are two ways to submit:

• Submit the information online, or

• Download and print the hardcopy form. After completing it, submit it via the contact the arbitration team form. (If you use this option, the form and your decision can be uploaded at the same time).

Arbitrator decision reporting form - “Appendix B”

The arbitrator decision reporting form is required for arbitration proceedings under RCW 48.49.040. This mandatory form for arbitrators to use is referred to as “Appendix B” in WAC 284-43B-037(6)(b) and WAC 284-43B-090. This form assists the OIC with its annual reporting requirements under RCW 48.49.050.  Submission of this form and the written decision satisfies the notification requirements under RCW 48.49.040(8)(a). Note: Appendix B cannot be used for arbitration decisions under RCW 48.49.135.

• Arbitrator decision reporting form

• Arbitrator Decision Reporting Form (PDF, 257.34 KB)

Arbitrator reporting form for proceedings under RCW 48.49.135 – "Appendix C"

The arbitrator decision reporting form is required for arbitration proceedings under RCW 48.49.135. This mandatory form for arbitrators to use is referred to as “Appendix C” in WAC 284-43B-037(6)(b) and WAC 284-43B-095. The form assists the OIC with its annual reporting requirements under RCW 48.49.050. Submission of this form and the written decision satisfies the reporting requirements under RCW 48.49.040(8)(a). 

• Arbitrator decision reporting form for arbitration proceedings under RCW 48.49.135

• Arbitrator decision reporting form for arbitration proceedings under RCW 48.49.135 (PDF, 236.46 KB)

The written decision

Arbitrators’ decision

RCW 48.49.040 lists the factors the arbitrator must consider in choosing one of the parties’ final offer amount. The arbitrator’s decision must include:

• Explanation of the elements of the parties' submissions the arbitrator relied upon to make their decision and
• Why those elements were relevant to their decision. 

What are the formatting guidelines?

There is no template or form for the written decision. We recommend that the decision:

• Be in a Word of PDF document file
• Header includes the parties' names and the arbitration initiation request form number

Arbitrator fees

Arbitrator fees must be paid by the parties within 30 calendar days of receipt of the arbitrator's decision. If the parties reach an agreement before the arbitrator makes their decision, any arbitrator fees must be paid by the parties within 30 calendar days of the date the settlement is reported to the OIC.

How to submit the written decision

The final written decision must be submitted to the arbitration team form.

Settlements before the final decision

If the parties settle before the arbitrator has decided, the parties must submit a settlement reporting form to the OIC. The arbitrator is not required to submit information about the parties’ settlement to the OIC.

How to submit an arbitration request form (Appendix A)

A health care provider, facility or health insurer can submit this Arbitration Initiation Request Form (AIRF) if the following is true:

• You are submitting this on behalf of a carrier, provider, or facility initiating arbitration under the Balance Billing Protection Act (BBPA). 
• The AIRF is submitted no later than 10 calendar days following the completion of the period of good faith negotiation.
• The most recent payment for the service in dispute was in the last 40 days. 
• The patient’s plan is regulated by the Office of the Insurance Commissioner (OIC) or is a self-funded group health plan that has elected to participate in the BBPA.
• The email address for the non-initiating party you are providing for the other party has been verified and is correct - Health plan arbitration contact information.
• You are not submitting any identifiable patient information with the AIRF. 
• You have read all the instructions on this page, including the notice requirements to the non-initiating party. 

Steps to initiate arbitration

1. Complete and submit the arbitration initiation request form
2. Email a copy of the confirmation page to the non-initiating party. Both of these steps must be completed by the initiating party.

Each submission is a distinct arbitration proceeding 

After you have gone through the screening steps and provided basic information about the parties, you will be asked to describe the health care services at issue and to complete the health care provider’s information. This information must be completed for each claim.

How to bundle claims into a single arbitration proceeding

Claims can be bundled in a single arbitration request. You may bundle up to 20 claims in a single filing if all the claims involve the same carrier and provider or facility, all have the same procedural code (or a comparable code under a different procedural system) and all occur within the same 30 business day period.

To submit bundled claims, select the number of claims being bundled on the health care provider information screen. The required information must be submitted for each claim. The form will not allow you to complete your submission without the required information for each claim. No additional documents can be uploaded.

How to print the confirmation page and send notice to the other party

The law requires that any information submitted to the OIC with the arbitration initiation request must be included in the notice to the non-initiating party. The party initiating the arbitration must provide written notification to the non-initiating party. To ensure that the non-initiating party receives all necessary information, OIC strongly encourages the initiating party to send a copy of the confirmation page (a copy of their completed arbitration initiation request form) to the non-initiating party’s verified email address to meet the notification requirement. 

To print the completed AIRF, select the “Submit” button. The completed form will display a confirmation screen. You will need to print this as a .PDF document. On most systems, this is done by right-clicking with your cursor and selecting “Print…” and then printing as .PDF. If your system does not have this capability, you may also take screenshots and save them as .JPEG or .GIF images that would be attached to the email notification to the non-initiating party. 

IMPORTANT: Do not exit out of the confirmation page before you have printed it. Once it has been closed, you will not be able to return to the confirmation page and will need to resubmit your AIRF. 

OIC encourages the initiating party to send electronic notification to the non-initiating party shortly after submission of the AIRF to OIC.

DO NOT copy the OIC BBPA arbitration team on the email notification to the non-initiating party. If the non-initiating other party claims they did not receive timely notice from you, they can raise that issue with the arbitrator at which time you will be required to show proof that timely notice was sent. 

What happens next

Within seven calendar days, the OIC BBPA arbitration team (through the OIC Administrative Hearings Unit) will conduct a review of your arbitration initiation request form and contact you. If your request was timely submitted and complete, the OIC will provide both parties with a unique number or designation for your arbitration initiation request (“AIRF Number”) as well as a link to the list of approved arbitrators or entities providing arbitration services. 

The parties must include the AIRF number in all communication related to that request. A party seeking to challenge whether a claim is eligible, appropriately bundled, etc., may raise those issues during arbitration.

Once that notification to the parties has been sent from the OIC BBPA Arbitration Team, the parties have 5 calendar days to notify the OIC of their selection of the arbitrator or to request a narrowed list of 5 arbitrators. If the parties still cannot agree, one will be assigned by the OIC from the narrowed list. 

Learn more about the BBPA arbitrator Arbitration selection process and the parties’ nondisclosure agreement.

Within ten business days of a party notifying OIC and the non-initiating party of the intent to initiate arbitration, both parties must agree to and execute a nondisclosure agreement. 

The timeframe for corrections and resubmissions

Except for typographical errors, any corrected AIRFs also must be submitted within 10 calendar days of the submission of the original request. A party that has submitted an untimely notice is permanently foreclosed from seeking arbitration related to the claim or claims that were the subject of the untimely notice.

Do you have an accessibility or accommodation request?

The law requires that this form be submitted electronically through the OIC’s website. If you have a disability and require assistance or accommodation, please contact the OIC BBPA arbitration team.

To learn more about the Balance Billing Arbitration Act and arbitration process.