HB469 Alabama 2025 Session

Summary

Primary Sponsor

Ed OliverRepresentative

Republican

Session

2025 Regular Session

Title

Ground ambulance services; prohibit out-of-network providers from balance billing

Summary

HB469 would end surprise billing from out-of-network ground ambulances by setting a minimum payment to providers and requiring insurers to pay them directly, with patients limited to in-network cost-sharing.

What This Bill Does

It sets a minimum reimbursement for out-of-network ambulance services equal to the lesser of the provider's billed charge or 325% of Medicare rate for the area. If the Medicare rate applies and the service is treated in place, the rate must be at least the published rate for emergency basic life support. It requires insurers to pay the ambulance service directly and prohibits balance billing of the enrollee beyond their in-network cost-sharing; it also outlines claims, dispute resolution, and that enrollees are not parties to payment disputes.

Who It Affects

• Enrollees/patients who need emergency ground ambulance transport, who would not be balance-billed beyond their in-network cost-sharing.
• Out-of-network emergency medical service providers and health insurers, who would be bound by direct payment rules, the minimum reimbursement rate, and dispute procedures.

Key Provisions

• Minimum reimbursement amount for out-of-network ground ambulance services: lesser of billed charge or 325% of Medicare rate in the service area; if applicable for treat-in-place, rate not less than the emergency basic life support code rate.
• Minimum reimbursement is payment in full; providers may not bill enrollees for amounts above the minimum reimbursement except for the enrollee's in-network cost-sharing.
• Health insurer must pay the EMS provider directly and certify the enrollee's in-network cost-sharing to the provider on request.
• Claim processing and disputes: insurers must pay clean claims within 30 days to the provider; send receipts or denial reasons for non-clean claims; disputes resolved via internal forum or mutually agreed dispute resolution contractor; enrollees are not participants in payer-provider disputes.
• Effective date: the act becomes effective October 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