SB52 Alabama 2024 Session

Summary

Primary Sponsor

Arthur OrrSenator

Republican

Session

Regular Session 2024

Title

Prohibit "balance billing" by out-of-network ground ambulances

Summary

SB52 would prohibit balance billing by out-of-network ground ambulance providers for emergency transport and set how insurers must pay these providers.

What This Bill Does

The bill bans out-of-network ground ambulance providers from charging enrollees more than their in-network cost-sharing for emergency transport. Insurers must certify to the provider the enrollee’s in-network cost-sharing amount. When paying the out-of-network provider, insurers would pay the median in-network amount for the area (or county outside the area) minus the enrollee’s in-network cost-sharing, and disputes can be resolved through specified internal mechanisms. The bill also authorizes the state Department of Insurance to collect data to determine medians and update them annually, with the new rules taking effect January 1, 2025.

Who It Affects

• Enrollees/insureds: cannot be balance billed for emergency ground transport and will pay only their in-network cost-sharing amount.
• Out-of-network ground ambulance providers and health insurers: insurers must pay providers using area- or county-based medians minus the enrollee’s cost-sharing, and disputes and data collection processes are defined.

Key Provisions

• Prohibits balance billing by out-of-network ground ambulance providers for emergency ground transport and limits collection to the enrollee's in-network cost-sharing amount.
• Requires insurers to certify to the provider the in-network cost-sharing amount the enrollee owes upon request.
• Payment to out-of-network providers: insurer pays the median in-network amount for the area (or county outside the area) minus the enrollee's in-network cost-sharing amount.
• Dispute resolution: allows disputes to be settled via the insurer's internal forum or a mutually agreed internal dispute resolution contractor; enrollees are not participants in these communications.
• Data collection and updates: the Commissioner may contract with a nonprofit to gather cost data and update medians annually, making information available to insurers and providers.
• Effective date: the act becomes effective January 1, 2025.

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