OLYMPIA, WA – Washington State Insurance Commissioner Mike Kreidler has directed Cambia Health Solutions, Inc., and its subsidiaries — including Regence BlueShield — to reprocess ground ambulance claims from approximately 670 policyholders who were balance billed by ambulance companies.
“Unfortunately, the insurer’s approach to this issue was not consistent with the law or the documents they have filed with our office. More importantly, it left consumers unfairly caught between the insurer and the providers,” Kreidler says. He added that his office is in discussions with Cambia on how to best resolve the issue and make the impacted consumers whole.
From Insurance Commissioner’s Office:
The policyholders had paid their cost-sharing amounts for ground ambulance transportation and Cambia paid its pre-determined rate to the ambulance companies. But because Cambia did not have a contract with the ambulance companies, consumers were billed the difference by the ambulance providers — a practice known as “balance billing.” In some cases, the consumers were charged hundreds of dollars on top of their cost-sharing amount. The ground ambulance providers sent some consumers to collections over these unpaid bills that in some cases were in the thousands of dollars.
Previously, Cambia had paid the amount the ground ambulance providers had billed and policyholders owed only their usual deductible or cost-sharing amount. Ground ambulance services are specifically carved out of Washington state’s Balance Billing Protection Act and the Federal No Surprises Act. Most ground ambulance providers do not have contracts with health insurers.
Kreidler’s office was directed by the Washington state Legislature to study how to prevent surprise billing from ground ambulance services and whether these services should fall under Washington’s Balance Billing Protection Act. The office’s report is due to the legislature on October 1, 2023.
Regardless of the underlying issue, Kreidler reminded all insurers to discuss significant changes in their interpretation of relevant laws with the OIC, particularly when those changes will impact consumers. Further administrative action against Regence is still under review.
“We are here to help, and we are always open to discussing the issues that insurers and others may have and changes they are considering,” Kreidler said. “Everyone is better off when folks come to us first — rather than leaving us to find out about the change when consumers call us with complaints.”
