SB313 Alabama 2024 Session

Summary

Primary Sponsor

Bobby D. SingletonSenator

Democrat

Session

Regular Session 2024

Title

Prohibit "balance billing" by ground ambulances

Summary

SB313 would end surprise balance billing for out-of-network ground ambulances by setting a minimum insurer payment (the lesser of the provider’s billed charge or 325% of the Medicare rate) and requiring insurers to pay the ambulance provider directly.

What This Bill Does

It sets a minimum reimbursement amount that health insurers must pay out-of-network ground ambulance providers for covered services, calculated as the lesser of the provider’s billed charge or 325% of the Medicare rate for the area. This minimum is treated as payment in full, and the provider cannot bill the patient beyond the in-network cost-sharing amount. The bill requires insurers to pay the ambulance provider directly and outlines a 30-day timeline for payment after a clean claim, with process for denials or requests for additional information. It also establishes dispute-resolution methods between insurers and providers and clarifies that enrollees are not parties to those disputes; the measure becomes effective October 1, 2024.

Who It Affects

• Out-of-network emergency ground ambulance providers would receive a defined minimum payment and be prohibited from charging patients beyond in-network cost-sharing.
• Enrollees/insured individuals would be protected from balance billed charges for emergency ground transport and would only pay their in-network cost-sharing amount.
• Health care insurers (and their agents) would be required to pay out-of-network ambulance providers directly and follow specified claim processing and dispute-resolution procedures.
• Self-funded plans may be exempt from some coverage mandates, with the bill making conforming changes to state law to reflect such carve-outs.

Key Provisions

• Minimum reimbursement amount: the lesser of the out-of-network EMS provider's billed charge or 325% of the Medicare rate in effect for the service area, paid by the insurer to the provider and deemed payment in full.
• Prohibition on balance billing: out-of-network EMS providers may not bill or collect from the enrollee any amount above the in-network cost-sharing amount for covered services.
• Direct insurer payment and timelines: insurers must pay the out-of-network provider directly within 30 days after receiving a clean claim; non-clean claims trigger required notifications and information requests.
• Dispute resolution: disputes over reimbursement can be settled via insurer-provider internal dispute resolution or a mutually agreed-upon dispute contractor, with enrollees not participating in these communications.
• Conforming amendments and effective date: the bill amends certain Alabama insurance and health plan statutes to implement these rules 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