Coverage for Out-of-network Ground Ambulance Emergency Services:
HB 425 would require Florida health insurers and health maintenance organizations that cover ground ambulance services to reimburse out-of-network or nonparticipating ambulance providers at a specified minimum rate. For both insurers and HMOs, payment would be the lowest of three benchmarks: the local governmental rate for the ambulance service, 325% of the applicable Medicare ground ambulance rate for the same service and area, or the provider’s billed charges. The bill applies to individual and group major medical coverage and would take effect January 1, 2026.
The bill also limits what patients can owe directly for these services. Once the insured or subscriber pays the applicable copayment, coinsurance, or deductible, that payment is treated as an accord and satisfaction and release of further claims related to the ambulance service. In addition, cost-sharing for out-of-network or nonparticipating ambulance services could not exceed the in-network cost-sharing amount for comparable covered services. The bill amends the Employee Health Care Access Act to require small employer carriers to follow these reimbursement rules as well.
HB 425 would create new statutory sections in the insurance code governing reimbursement for ground ambulance emergency services, and it would extend those requirements to both health insurers and HMOs. It would also amend the small-employer health coverage provisions so small employer carriers must comply, and it would treat ambulance service providers as providers subject to existing claims-related statutes referenced in the bill. The practical effect would be to establish a statewide payment standard for out-of-network ambulance claims and to cap patient cost-sharing for covered ground ambulance transport.
The available record shows no committee transcript or recorded votes, so there is no detailed debate history to gauge support or opposition. The bill’s structure suggests a consumer-protection and provider-payment approach aimed at reducing surprise billing for emergency ambulance transport while ensuring ambulance providers receive a defined reimbursement floor. Its final status indicates it did not advance, as it died in the Commerce Committee.
The main policy tension in HB 425 is between controlling patient out-of-pocket exposure and insurer costs on one hand, and setting a mandated reimbursement formula for ambulance providers on the other. Potential points of contention include the 325% of Medicare benchmark, the use of local governmental rates where available, and whether the bill’s cost-sharing limits and release language could affect billing practices or contract negotiations. Because there are no transcripts, the specific objections or supporters are not identified, but the likely stakeholders are health insurers, HMOs, ambulance service providers, employers, and consumers facing emergency transport charges.