Washington state directs Regence BlueShield to correct ambulance balance billing claims

The Washington state insurance commissioner is directing Cambia Health Solutions, parent company of Regence BlueShield, to correct claims in which members were "balance billed" for ambulance services. 

According to a May 25 news release, around 670 policyholders were charged for the difference between what ground ambulance providers charged and Cambia's reimbursement rates. 

Ground ambulance services are not included in the No Surprises Act, which prevents patients from receiving out-of-network charges for emergency services. Around half of people with private insurance receive out-of-network bills for ambulance services, according to a 2021 analysis from KFF. 

Though ground ambulances are exempted from the No Surprises Act, Washington Insurance Commissioner Mike Kreidler said Cambia had previously paid what the ambulance providers billed, and members were only responsible for their usual copay and deductible rates for ground ambulance services. 

Cambia Health Solutions operates Blue Cross Blue Shield affiliates in Washington, Oregon, Idaho and Utah. 

"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," Mr. Kreidler said. 

According to the news release, the Washington Legislature has directed the insurance commissioner's office to study how to prevent surprise billing from ambulance services. 

"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," a spokesperson for Cambia Health Solutions told Becker's. 

Mr. Kreidler said his office is working with Cambia Health Solutions to resolve the interpretation of the law.

 "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," the spokesperson for Cambia Health Solutions added. 

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