HB401 Alabama 2024 Session

Summary

Primary Sponsor

Ed OliverRepresentative

Republican

Session

Regular Session 2024

Title

Prohibit "balance billing" by ground ambulances

Summary

HB401 would end surprise balance billing for out-of-network emergency ground ambulance services by setting a minimum payment rate and requiring insurers to pay providers directly.

What This Bill Does

It sets a minimum reimbursement for out-of-network ground ambulance services at the lesser of the provider's billed charge or 325% of the Medicare rate for the service area, treated as payment in full. It prohibits providers from billing the patient beyond this minimum, except for the patient’s in-network cost-sharing. It requires health insurers to pay the ambulance service directly and to provide the provider with the enrollee’s in-network cost-sharing amount upon request. It also outlines claim handling timelines, denial procedures for non-clean claims, and dispute resolution options between the insurer and provider, while excluding the enrollee from those communications; it also amends related Alabama insurance laws and sets an effective date.

Who It Affects

• Enrollees who receive emergency ground ambulance services from out-of-network providers would be protected from balance billing and would pay only their in-network cost-sharing amount.
• Out-of-network emergency ambulance providers and health insurers would be subject to new payment rules, including the minimum reimbursement amount, direct payment requirements, and dispute resolution processes.

Key Provisions

• Minimum reimbursement amount for out-of-network ground ambulance services: the lesser of the provider's billed charge or 325% of the Medicare rate in effect for the geographic area where the service is provided, treated as payment in full.
• No balance billing: out-of-network providers may not bill or collect any amount from an enrollee that exceeds the minimum reimbursement amount, except for the enrollee's in-network cost-sharing.
• Insurer payments to providers: health insurers must pay the ambulance service directly and certify the enrollee's in-network cost-sharing amount to the provider upon request.
• Claims processing: insurers must remit payment within 30 days after receipt of a clean claim and not pay the enrollee; non-clean claims require a written receipt with denial or information needs, and disputes may be resolved through specified internal mechanisms.
• Legal changes and effective date: the act amends Sections 10A-20-6.16 and 27-21A-23 of the Alabama Code and becomes effective October 1, 2024.

AI-generated summary using openai/gpt-5-nano on Feb 22, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Insurance