Surprise bills and ambulance bills in Washington
Out-of-network providers and facilities may not balance bill you for emergency services, for non-emergency care by out-of-network providers at in-network facilities, or for air ambulance services.
Checked against official sources: October 30, 2026.
What Washington adds
- State law
Balance Billing Protection Act, including ground ambulance rules (2024)
Law: RCW 48.49; RCW 48.49.020, 48.49.030, 48.49.120, 48.49.130, 48.49.200, 41.05.017
- Which plans it covers
Health plans regulated by the Washington Office of the Insurance Commissioner, health plans for public and school employees offered through the Health Care Authority (PEBB and SEBB), and self-funded employer plans that choose to join. It does not apply to Apple Health (Medicaid) plans, which have their own rules.
- What it adds
Out-of-network providers and facilities may not balance bill you for emergency services, for non-emergency care by out-of-network providers at in-network facilities, or for air ambulance services. The state also protects you from balance bills for emergency care from out-of-network behavioral health emergency providers (such as mobile crisis teams). You cannot be asked to sign away these protections. If you paid more than your in-network share, the provider must refund it within 30 business days, or pay 12% interest after that.
- Ground ambulance
The state protects you
For state-regulated plans issued or renewed on or after January 1, 2025, an out-of-network ground ambulance may not bill you more than your in-network cost sharing for a covered ride. The insurer pays the ambulance directly. If you paid more, the ambulance must refund it within 30 business days, or pay 12% interest after that. You cannot be asked to sign away this protection. This rule protects people in covered health plans; the state law does not set a limit for people without insurance.
Law: RCW 48.49.200, 48.49.130
Law: RCW 48.49.020, 48.49.030, 48.49.120, 48.49.130, 48.49.200, 41.05.017
Itemized bills and price estimates in Washington
Washington law gives you a right to an itemized bill.
If a collection agency is collecting a medical debt, you can ask in writing or by phone for a free itemized statement. Until the agency sends it, it must stop all collection efforts (court writs already issued may continue). The statement must show the provider's name and address, the dates of service, the services, the principal, insurance adjustments and discounts, payments received, any interest or fees, and whether you were found eligible for charity care and the amount due after it. Hospitals must also give inpatients, at or before discharge, a list of the doctor groups that may bill them separately, with phone numbers.
Law: RCW 19.16.250(28)(a); RCW 70.41.400(1)
Where to complain in Washington
- Hospital bills and financial assistance: Washington State Department of Health, charity care program · 360-236-4210
A hospital is not following its charity care policy, unfairly denied you charity care, or refused to give you an application. - Hospital licensing: Washington State Department of Health, complaints about providers and facilities · 360-236-4700
Other complaints about a hospital or a licensed health care provider. - Health insurance: Washington State Office of the Insurance Commissioner · 1-800-562-6900
A surprise bill, ground ambulance bill or claim denial under a state-regulated health plan. - Attorney general: Washington State Attorney General, Consumer Protection · 1-800-551-4636
A collection agency or business broke consumer protection rules, including medical debt collection and credit reporting rules.
Free tools, letters and checklist
Questions about medical bills in Washington
Am I protected from ground ambulance bills in Washington?
For state-regulated plans issued or renewed on or after January 1, 2025, an out-of-network ground ambulance may not bill you more than your in-network cost sharing for a covered ride. The insurer pays the ambulance directly.