SB1925 Summary

• Amends the Illinois Insurance Code to include ground ambulance services in the definition of "health care services" and requires health insurance issuers to cover emergency ground ambulance transportation without balance billing protections previously excluded.

• Establishes that when beneficiaries receive emergency services from nonparticipating providers or facilities, they pay no more out-of-pocket costs than with in-network providers, with cost-sharing calculated based on the recognized amount.

• Creates a binding arbitration process for payment disputes between nonparticipating providers and health insurance issuers when negotiation fails within 30 days, using American Arbitration Association or American Health Lawyers Association trained arbitrators.

• Adds subsection (o) specifying that nothing requires ambulance providers to bill beneficiaries when prohibited by other law, rule, ordinance, contract, or agreement, with special provisions for local government ambulance providers.

• Removes language from the Health Maintenance Organization Act requiring HMOs to promptly pay ambulance providers upon demand and prohibiting providers from seeking payment from enrollees.