Bill would ban surprise ambulance billing

MONTGOMERY — A bill that would prohibit surprise billing for ambulance services was filed recently in the Alabama Legislature in hopes that it will, at minimum, serve as a negotiating tool to compel health insurance companies to expand their coverage for such services.

"The amount of money that people end up paying ... they think they have insurance, and then all of a sudden you get a bill," said Rep. Ed Oliver, R-Dadeville, the sponsor of the bill, speaking with Alabama Daily News last week

House Bill 469 would mandate minimum reimbursement rates for insurance providers to pay out-of-network ambulance services: either the entire bill or 325% of the Medicare rate for the relevant geographic area, whichever is less. Patients could not be billed for any additional fees by providers or their health insurance, beyond standard in-network cost-sharing fees like deductibles or copays.

The intent of the bill, Oliver told ADN, was to compel health insurance companies to expand the number of ambulance service providers considered in network and force them to the negotiating table.

"The tendency is to try to force the ambulance services out of network for obvious reasons," he said. "Insurance companies would do that. So, this bill does exactly the opposite, it forces the insurance companies to have to cover ambulance services. It's as simple as that."

Instances of limited availability for ambulance service providers are most common in Alabama's rural communities, such as in Pickens County near Tuscaloosa, which since 2022 has not had a hospital, and more often than not, only one ambulance available.

Last week, U.S. Rep. Terri Sewell introduced a bill to protect the county's limited ambulance service by increasing Medicare premiums for ambulance service providers in rural communities.

For non-Medicare patients, however, out-of-network ambulance services can cost thousands of dollars.

Oliver also filed House Bill 478, which would also mandate ambulance service reimbursement rates, though at only 185% of the Medicare rate for the relevant geographic area as opposed to the 325% under HB469.

Unlike HB469, HB478 would also sunset in June of 2029, and require the Alabama Department of Public Health to conduct a two-year study on the bill's impact, particularly on rural ambulance access and response times. Those findings would then be reported to Blue Cross Blue Shield of Alabama, which holds a 92% share of the health care insurance market in the state, as well as to the Alabama Association of Ambulance Services by January of 2028.

A representative for Blue Cross Blue Shield of Alabama did not comment on Oliver's bills specifically, but did say the company would continue to work with lawmakers to "satisfy all stakeholders."

"Blue Cross and Blue Shield of Alabama remains committed to advocating on behalf of our members and collaborating with policymakers to develop a bill that will satisfy all stakeholders," Sophie Martin, director of Corporate Communications and Community Relations for Blue Cross Blue Shield of Alabama, told ADN Monday in an email.

Oliver, a former ambulance helicopter pilot for the U.S. Army, had filed a similar bill in 2024, which he said was for the same purpose.

"It is a placeholder to force Blue Cross to negotiate," Oliver said. "I did it last year."

Both bills have been assigned to the House Insurance Committee, which is next scheduled to meet Wednesday at the Alabama State House.