Bill > SB1504

This bill establishes new rules for how health insurance plans, referred to as "health benefit plans" issued by "health carriers," must pay ambulance providers for emergency services. It defines an "ambulance provider" as any ambulance service, excluding air ambulances, and clarifies terms like "clean claim" (a claim without errors that prevents payment), "covered services" (emergency ambulance services covered by the plan), and "out-of-network ambulance provider" (one that doesn't have a contract with the patient's health carrier). For out-of-network providers, the bill mandates a minimum reimbursement rate, which is either the rate set by a local government or, if none exists, 325% of the Medicare rate for the same service in the same area, or the provider's billed charges, whichever is less. Payments made under these rules are considered full payment for covered services, except for patient cost-sharing like co-payments, and providers are prohibited from billing patients for any additional amounts. Patient cost-sharing for these out-of-network services cannot exceed what they would pay for in-network services. Health carriers must pay clean claims within thirty days directly to the ambulance provider, not the patient, and if a claim is not clean, they must notify the provider within thirty days, explaining why it's being denied or what additional information is needed. This new section will take precedence over any conflicting laws.

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https://www.senate.mo.gov/26info/BTS_Web/Bill.aspx?SessionType=R&BillID=74581