Washington Insurance Commissioner Directs Insurer to Reprocess Ground Ambulance Claims


Washington state Insurance Commissioner Mike Kreidler has taken action against Cambia Health Solutions, Inc., and its subsidiaries, including Regence BlueShield, instructing them to reprocess ground ambulance claims for around 670 policyholders who were unfairly billed by ambulance companies.

Kreidler expressed his disappointment with the insurer's handling of the matter, stating that their actions were not in accordance with the law or the documents they had filed with his office. He emphasized the negative impact on consumers, who found themselves caught between the insurance provider and the ambulance service providers. 

Kreidler revealed ongoing discussions with Cambia to find the best solution and ensure affected consumers are fully compensated.

The policyholders in question had already paid their cost-sharing amounts for ground ambulance transportation, while Cambia had paid the predetermined rate to the ambulance companies. However, due to the absence of a contract between Cambia and the ambulance companies, consumers were billed for the remaining difference, a practice commonly referred to as "balance billing." In some cases, these bills amounted to hundreds of dollars on top of the cost-sharing amount, with certain consumers even facing collections for unpaid bills reaching thousands of dollars.

Historically, Cambia had covered the amount billed by ground ambulance providers, with policyholders only responsible for their usual deductible or cost-sharing amount. Ground ambulance services, unlike other health care services, are not protected by Washington state's Balance Billing Protection Act or the Federal No Surprises Act, largely because most providers in this sector do not have contracts with health insurers.

The Washington state Legislature had tasked Kreidler's office with studying ways to prevent surprise billing from ground ambulance services and determining whether such services should be included in the Balance Billing Protection Act. A report on the matter is expected to be submitted to the legislature by Oct. 1, 2023.

Regardless of the underlying issue, Kreidler reminded all insurers of the importance of consulting with the Office of the Insurance Commissioner regarding significant changes in their interpretation of relevant laws, especially when the changes have an impact on consumers. Further administrative action against Regence is currently being reviewed.

Kreidler emphasized the commitment of his office to assist and address concerns raised by insurers and others, urging them to proactively engage in discussions rather than waiting for consumer complaints. He highlighted the benefits of collaboration, stating that everyone benefits when issues are addressed cooperatively.

Regence BlueShield issued a statement after Kreidler's announcement. 

"Our top priority is caring for our members, including protecting them from unreasonable costs and balance billing," RegenceBlueShield stated. "Based upon current regulations, we interpreted the No Surprises Act’s consumer protections against balance billing to apply to emergency situations when a member is transferred to another facility after being admitted to the emergency room, and we processed our members’ claims as such. The Washington Office of the Insurance Commissioner and the ground ambulance companies disagree, so we are working with both entities to reach an agreement on behalf of our members and a plan for processing these types of claims going forward."