Insurance Commissioner: Companies overcharged for ambulance rides

Hundreds of people in Washington state could see refunds from their health insurance companies after being overcharged for ambulance rides.

State Insurance Commissioner Mike Kreidler said Cambia Health Solutions and its subsidiaries, including Regence BlueShield, improperly processed claims from customers, which led to health service providers “balance billing” 670 insurance claims. “Balance billing” means that health providers charged consumers any amount over the agreed-upon rate for an ambulance ride if the ambulance company wasn’t contracted with the insurance company.

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In some cases, people had to pay a difference of several hundred dollars directly to the ambulance companies on top of the amount paid to their insurance provider. Ambulance providers sent some consumers to collections over unpaid bills that, in some cases, were in the thousands of dollars.

Balance billing is illegal under Washington’s Balance Billing Protection Act, which puts a cap on what any enrollee will pay for emergency health services not contracted with their health plan to only be what their cost-sharing amount is. That practice is also not allowed under the federal No Surprises Act.

Ground ambulance services are specifically carved out of Washington state’s Balance Billing Protection Act, though, since most ground ambulance providers do not have contracts with health insurers.

The State Insurance Commissioner’s Office said that this refund affects around 670 policyholders.

“Unfortunately, the insurer’s approach to this issue was not consistent with the law or the documents they have filed with our office,” Kreidler said in a statement about the refund. “More importantly, it left consumers unfairly caught between the insurer and the providers.”

The Office of the Insurance Commissioner was directed by the Legislature to investigate how to prevent people from getting unexpected bills from medical services, with their report due back to the Legislature in October.

Further administrative action against Regence BlueShield 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.”

Regence BlueShield issued the following statement about the issue.

Our top priority is caring for our members, including protecting them from unreasonable costs and balance billing. 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.

Editor’s Note: This story has been updated to reflect that it was the ambulance providers charging customers instead of insurance providers.