HB478 Alabama 2025 Session

Summary

Primary Sponsor

Ed OliverRepresentative

Republican

Session

2025 Regular Session

Title

Health insurers; minimum reimbursement rate for ambulance services that are out-of-network established

Summary

HB478 would curb surprise ambulance bills by requiring insurers to pay out-of-network emergency ambulance claims promptly and at a high minimum rate, while shielding enrollees from balance billing, and it would study the impact for rural areas before sunsetting in 2029.

What This Bill Does

It would prohibit balance billing to enrollees for emergency ambulance services and cap what enrollees owe to the in-network cost-sharing amount. It would require health insurers to reimburse ambulance providers within 30 days of receiving a claim and set a minimum out-of-network reimbursement of 185% of CMS rates, with payment made at the greater of the in-network rate or the minimum. It also requires a two-year study by the Alabama Department of Public Health on the act’s effects, with the act becoming effective October 1, 2025 and repealing on June 1, 2029.

Who It Affects

• Enrollees/insured individuals who receive emergency ambulance services: they would pay no more than in-network cost-sharing and would be protected from balance billing for paid services.
• Out-of-network ambulance providers: they would receive a guaranteed minimum reimbursement (185% of CMS rates) and would be paid within 30 days, with the payment amount equal to the greater of the in-network rate or the out-of-network minimum.

Key Provisions

• Minimum reimbursement for out-of-network emergency ambulance services is 185% of CMS rates, and the insurer must pay the greater of the in-network rate or the out-of-network minimum.
• Balance billing for paid covered ambulance services is prohibited; enrollees’ cost-sharing cannot exceed in-network amounts, and clean claims must be paid within 30 days with a specific payment remark code; a two-year ADPH study on impacts is required, with sunset provisions.

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