Prohibit "balance billing" by ground ambulances
This legislation will significantly influence how ground ambulance services operate and how health insurers handle emergency transport claims. By prohibiting surprise billing, SB313 aims to alleviate financial burdens on individuals, making it easier for them to manage emergency medical expenses. Moreover, the measure requires health insurers to pay out-of-network ambulance services directly rather than through the insured individual, simplifying the payment process and further protecting consumers from unexpected financial consequences.
SB313 aims to tackle the issue of surprise billing practices by out-of-network ground ambulance providers. Currently, many ambulance services not in a patient's insurance network can charge the patient the difference between what the insurer pays and the provider's full fee, a practice often described as balance billing or surprise billing. This bill seeks to prevent such practices by setting a minimum reimbursement rate for these services, which will be deemed as payment in full. Specifically, the new rate will be a multiple of the Medicare reimbursement amount for ground ambulance services, thereby ensuring that insured individuals are no longer subjected to unexpected medical bills following emergency transport.
Notably, there are potential points of contention surrounding the bill. Opponents may raise concerns about the financial viability for out-of-network ambulance providers, who may find the reimbursement rates insufficient for operations, particularly in areas where costs may exceed the set reimbursement amount. Furthermore, the bill could face scrutiny related to how it will affect the dynamics between insurers and emergency medical providers, especially concerning pricing and negotiations over reimbursements. Stakeholders will need to balance consumer protections with the economic sustainability of ambulance services.