CA AB2709

Health care service plans and health insurance policies issued, amended, or renewed on or after January 1, 2023 must cap patient cost-sharing for noncontracting ground ambulance services at the same amount charged for contracting providers.

Noncontracting ground ambulance providers are prohibited from billing patients more than the in-network cost-sharing amount and can only advance unpaid in-network amounts to collections.

Plans and insurers must reimburse noncontracting ground ambulance providers at the greater of either the average contracted rate or 125% of the Medicare reimbursement rate for the geographic region where services were rendered.

In-network cost-sharing amounts paid by enrollees and insureds count toward annual out-of-pocket expense limits and deductibles the same as contracting provider services.

Either party may appeal disputed reimbursement amounts through the independent dispute resolution process established by the Department of Managed Health Care or Insurance Commissioner.