The proposed bill aims to protect patients from unexpected charges related to ground ambulance services by implementing several key measures:
Rate Submission and Transparency: Political subdivisions or their contracted ambulance services can submit their established service rates to the Division of Insurance, provided these rates meet specific criteria. The Division is then required to publish these reimbursement rates on a publicly accessible website, ensuring transparency for consumers.
Standardized Reimbursement for Out-of-Network Services: The bill sets defined reimbursement rates for out-of-network ambulance services. This standardization ensures that insurance carriers reimburse these services at rates consistent with those established by local authorities or, if not submitted, at a rate up to 325% of what Medicare would pay.
Prohibition of Balance Billing: Out-of-network ambulance providers are prohibited from billing patients for any outstanding balances beyond what their insurance covers, except for standard cost-sharing amounts like coinsurance, deductibles, or copayments. Payments made by patients for out-of-network services must be applied toward their in-network deductibles and out-of-pocket maximums, preventing additional financial burdens.
By implementing these measures, the bill seeks to eliminate surprise medical bills for ambulance services, promote fair compensation for providers, and enhance transparency in billing practices.
Summary
For ground ambulance services (ambulance services), the bill: •
Allows a political subdivision or an ambulance service providing ambulance services on behalf of the political subdivision to submit to the division of insurance (division) the established rates for the ambulance services, if the rates meet specified conditions; •
Requires the division to publish reimbursement rates on the division's public-facing website;
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Establishes reimbursement rates for ambulance services that are out of network; and
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Prohibits an out-of-network ambulance service from billing an individual covered under a health insurance coverage plan (covered person) any outstanding balance for a covered service not paid for by an insurance carrier, except for any coinsurance, deductible, or copayment amount required to be paid by the covered person. If a covered person makes a payment for an out-of-network ambulance service, the payment must be applied to the covered person's in-network deductibles and in-network out-of-pocket maximum amounts.
