The bill seeks to enhance consumer protections against unexpected charges from out-of-network health care services, specifically targeting balance billing for ground ambulance services. It introduces new definitions for "ground ambulance services" and "ground ambulance services organization," clarifying the scope of services provided by licensed entities. The legislation amends existing laws to ensure that enrollees are only responsible for in-network cost-sharing amounts, prohibits balance billing for covered ground ambulance services starting January 1, 2025, and requires nonparticipating providers to negotiate payments in good faith with health carriers. Additionally, it updates the minimum deductible and out-of-pocket expense requirements for catastrophic health plans, setting them at $1,750 for individuals and $3,500 for families.

Moreover, the bill mandates that ground ambulance service organizations provide clear consumer rights notices and maintain updated information on their websites regarding in-network services. It establishes enforcement mechanisms for violations, including potential fines and disciplinary actions against non-compliant providers and carriers. The legislation also requires health carriers to cover ground ambulance transports to behavioral health emergency services without prior authorization and includes provisions for the insurance commissioner to review ground ambulance service rates. Overall, the bill aims to improve transparency, protect consumers from excessive charges, and ensure adequate funding and access to emergency medical services.

Statutes affected:
Original Bill: 48.43.005, 48.49.003, 48.49.060, 48.49.070, 48.49.090, 48.49.100, 18.130.040, 48.49.190
Substitute Bill: 48.43.005, 48.49.003, 48.49.060, 48.49.070, 48.49.090, 48.49.100, 18.130.040, 48.49.190
Bill as Passed Legislature: 48.43.005, 48.49.003, 48.49.060, 48.49.070, 48.49.090, 48.49.100, 18.130.040, 48.49.190
Session Law: 48.43.005, 48.49.003, 48.49.060, 48.49.070, 48.49.090, 48.49.100, 18.130.040, 48.49.190