Bill > HB469

This bill addresses balance billing for ground ambulance services in Alabama by establishing comprehensive protections for patients (called "enrollees") when receiving emergency medical services from out-of-network providers. The legislation defines key terms such as emergency medical service providers, covered services (including emergency ground transport and "treat in place" services), and establishes a reimbursement mechanism that limits what out-of-network providers can charge. Specifically, the bill mandates that health care insurers pay out-of-network emergency medical service providers the lesser of their billed charge or 325% of the Medicare rate for the geographic area, effectively preventing these providers from billing patients for additional amounts beyond the patient's standard in-network cost-sharing amount. The bill requires insurers to pay providers directly within 30 days of receiving a clean claim, prohibits providers from billing patients for amounts above the determined reimbursement rate, and establishes a process for resolving payment disputes between insurers and providers without involving the patient. The law is set to take effect on October 1, 2025, and applies to all health care benefit plans issued or renewed in Alabama, with certain specific insurance types exempted from the requirements.

Business and Industry

https://alison.legislature.state.al.us/bill-search