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December 10, 2024
The Washington Balance Billing Protection Act (BBPA), enacted in 2020, protects patients from balance billing when receiving emergency care from an out-of-network provider. Effective Jan. 1, 2025, the BBPA is expanding to add new protections against balance billing for covered emergency and nonemergency Washington-based ground ambulance services that are not included in the federal No Surprises Act (NSA).
In addition, new BBPA rules include the following consumer protections:
- Health plans must cover transport to behavioral health crisis centers as an alternative to hospital ERs.
- Cost-sharing must be the same for out-of-network (OON) providers and in-network (INN) providers, and it must be applied to the member’s INN deductible and out-of-pocket limit.
- Any member overpayment must be refunded, with interest.
- Providers cannot ask or require members to waive their balance billing protections. (For self-funded group health plans that have not opted into the BBPA, NSA notice and consent provisions apply.)
- Rate formulas are used for OON ground ambulance transports.
The BBPA automatically applies to fully insured health plans sold in Washington. For the complete list of all BBPA protections please visit the Balance Billing Protection Act website.
Most of our self-funded groups are opted in to the BBPA. As required by the Washington Office of the Insurance Commissioner (OIC), by Dec. 31, 2024, we are refiling each self-funded group’s BBPA opt-in decision with the OIC to ensure all enrollees continue receiving the financial protections specified in the BBPA.
New and renewing self-funded groups with Jan. 1, 2025 effective dates not previously opted in to the BBPA must notify us by Dec. 31, 2024, if they wish to opt in.
Questions? Please contact your account representative.