This bill mandates that insurers directly reimburse ambulance service providers for the full amount billed or at rates negotiated between the insurer and the provider. The current language that allowed reimbursement to be subject to the terms of the policy has been removed. The bill specifies that if no negotiated rates exist, insurers must pay the billed amount, with the insurance department reviewing any disputes regarding the reasonableness of the charges. Additionally, the bill clarifies that it does not apply to policies lacking coverage for ambulance services and allows insurers to negotiate contracts with non-participating ambulance providers.

The bill is expected to increase claims costs for emergency ground ambulance services significantly, with estimates suggesting an increase of at least $11.8 million annually. This increase is attributed to the difference between current negotiated rates and the billed amounts. The Insurance Department anticipates a surge in dispute resolution requests due to the potential for disagreements over billed rates, which may necessitate additional administrative resources. While the bill does not allocate funding for these administrative needs, it is projected that increased claims costs and legal fees could lead to higher health insurance premiums, impacting local and county expenditures. The overall fiscal impact remains indeterminable at this time.

Statutes affected:
Introduced: 415:6-q, 415:18-v