AL HB469

Establishes a minimum reimbursement rate for out-of-network ground ambulance providers equal to the lesser of the provider's billed charge or 325 percent of the Medicare rate for the geographic area where services are provided.

Prohibits out-of-network ground ambulance providers from billing or collecting any amount from enrollees exceeding the minimum reimbursement rate, except for the enrollee's in-network cost-sharing amount.

Requires health care insurers to remit payment directly to out-of-network ambulance providers within 30 days of receiving a clean claim, rather than sending payment to the enrollee.

Establishes procedures for handling non-clean claims, including 30-day written notification with specific reasons for denial or additional information needed.

Becomes effective October 1, 2025.