Coverage for Out-of-network Ground Ambulance Emergency Services
Summary
HB 425 creates new statutory protections for consumers and reimbursement rules for ground ambulance services when the ambulance provider is out of network or otherwise nonparticipating. For both health insurers and health maintenance organizations, the bill requires payment to a nonparticipating ambulance service provider at the lowest of three benchmarks: the local government rate for the service, 325% of the applicable Medicare ground ambulance rate for the same geographic area, or the provider’s billed charges. The bill applies these rules to individual and group major medical coverage that includes ground ambulance services, and it also directs small employer carriers to follow the same reimbursement standards.
The bill also limits what insureds or subscribers can be billed out of pocket for these services. It provides that payment of the applicable copayment, coinsurance, or deductible constitutes an accord and satisfaction and release of additional claims related to the ambulance service, and it caps cost-sharing for out-of-network ambulance services at the in-network level for HMO coverage. The measure further treats ambulance service providers as providers subject to existing claims-processing statutes, and it takes effect January 1, 2026.
Impact
HB 425 would add new sections to the Florida Insurance Code governing reimbursement for out-of-network ground ambulance emergency services, affecting both commercial health insurers and health maintenance organizations. It would also amend the Employee Health Care Access Act to require small employer carriers to comply with the same reimbursement framework. The bill would likely affect ambulance service providers, insurers, HMOs, employer-sponsored coverage, and insured patients by standardizing payment methodology and limiting balance billing and cost-sharing exposure for covered ground ambulance transports.
Sentiment
The available voting history suggests strong support for the bill, with the House Health Care Facilities & Systems Subcommittee approving it 16-0 on March 27, 2025. No committee transcript excerpts were provided, so there is no recorded debate to indicate organized opposition in the materials supplied. Overall, the bill appears to have been received favorably at the committee stage, likely because it addresses surprise billing and consumer cost exposure for emergency ambulance services.
Contention
The main policy tension in the bill is between consumer protection and reimbursement levels for ambulance providers. Supporters are likely to view the measure as a way to prevent patients from receiving large unexpected bills for emergency ground ambulance transport and to align cost-sharing with in-network standards. Potential concerns could come from insurers, HMOs, or local governments over the mandated payment formula, especially the 325% of Medicare benchmark and the use of local government-set rates, which may increase plan costs or reduce flexibility in negotiations. Ambulance providers may also have differing views depending on whether the formula adequately covers their costs.