# WAC 284-43B-025: WAC 284-43B-025. Balance billing prohibition and consumer cost-sharing for ground ambulance services > Washington · Regulations · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_025 ## Section - **Citation:** WAC 284-43B-025 - **Heading:** WAC 284-43B-025. Balance billing prohibition and consumer cost-sharing for ground ambulance services - **Jurisdiction:** Washington - **Kind:** Regulations - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** Washington Administrative Code / Title 284 / Chapter 284-43B / Section 284-43B-025 ## Text If an enrollee receives covered ground ambulance services: (1) The enrollee satisfies their obligation to pay for the ground ambulance services if they pay the in-network cost-sharing amount specified in the enrollee's applicable health plan contract. The enrollee's obligation must be calculated using the allowed amount determined under WAC 284-43B-027 . The carrier shall provide an explanation of benefits to the enrollee and the nonparticipating ground ambulance services organization that reflects the cost-sharing amount determined under this subsection; (2) The carrier, nonparticipating ground ambulance services organization, and any agent, trustee, or assignee of the carrier or nonparticipating ground ambulance services organization shall ensure that the enrollee incurs no greater cost than the amount determined under subsection (1) of this section; (3) The nonparticipating ground ambulance services organization and any agent, trustee, or assignee of the nonparticipating ground ambulance services organization may not balance bill or otherwise attempt to collect from the enrollee any amount greater than the amount determined under subsection (1) of this section. This does not impact the ground ambulance services organization's ability to collect a past due balance for that cost-sharing amount with interest; (4) The carrier shall treat any cost-sharing amounts determined under subsection (1) of this section paid by the enrollee for a nonparticipating ground ambulance services organization's services in the same manner as cost-sharing for health care services provided by a participating ground ambulance services organization and must apply any cost-sharing amounts paid by the enrollee for such services toward the enrollee's maximum out-of-pocket payment obligation; and r subsection (1) of this section paid by the enrollee for a nonparticipating ground ambulance services organization's services in the same manner as cost-sharing for health care services provided by a participating ground ambulance services organization and must apply any cost-sharing amounts paid by the enrollee for such services toward the enrollee's maximum out-of-pocket payment obligation; and (5) A ground ambulance services organization shall refund any amount in excess of the in-network cost-sharing amount to an enrollee within 30 business days of receipt if the enrollee has paid the nonparticipating ground ambulance services organization an amount that exceeds the in-network cost-sharing amount determined under subsection (1) of this section. Interest must be paid to the enrollee for any unrefunded payments at an annual rate of 12 percent beginning on the first calendar day after the 30 business days. ## Nearby sections - [WAC 284-43B-010 WAC 284-43B-010. Definitions](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_010.md) - [WAC 284-43B-015 WAC 284-43B-015. Coverage of emergency services](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_015.md) - [WAC 284-43B-020 WAC 284-43B-020. Balance billing prohibition and consumer cost-sharing](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_020.md) - [WAC 284-43B-025 WAC 284-43B-025. Balance billing prohibition and consumer cost-sharing for ground ambulance services](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_025.md) - [WAC 284-43B-027 WAC 284-43B-027. Payments to nonparticipating ground ambulance services organizations](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_027.md) - [WAC 284-43B-029 WAC 284-43B-029. Local governmental entity rate reporting to the insurance commissioner](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_029.md) - [WAC 284-43B-030 WAC 284-43B-030. Out-of-network claim payment and placing a claim into dispute](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_030.md) - [WAC 284-43B-032 WAC 284-43B-032. Applicable dispute resolution system](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_032.md) - [WAC 284-43B-035 WAC 284-43B-035. Arbitration initiation and selection of arbitrator](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_035.md) - [WAC 284-43B-037 WAC 284-43B-037. Arbitration proceedings](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_037.md) - [WAC 284-43B-040 WAC 284-43B-040. Determining whether an enrollee's health plan is subject to the requirements of the act](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_040.md) - [WAC 284-43B-050 WAC 284-43B-050. Notice of consumer rights and transparency](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_050.md) - [WAC 284-43B-060 WAC 284-43B-060. Enforcement](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_060.md) - [WAC 284-43B-070 WAC 284-43B-070. Self-funded group health plan opt in](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_070.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_025. Check the current official text before relying on it. Not legal advice.