No Surprises for Ambulance Services Act
House Bill 456, titled the No Surprises for Ambulance Services Act, would change North Carolina insurance law to make ground ambulance coverage more consistent and transparent for consumers. The bill amends the state’s emergency-services coverage statute to require insurers to cover emergency ambulance transportation when a prudent layperson would reasonably believe an emergency exists, and it bars insurers from imposing higher cost-sharing for emergency ambulance services than they would apply if the provider were in-network. It also requires insurers to provide clearer information to covered persons about emergency services, 911 use, cost-sharing, and how to access emergency care.
The bill also creates a new rule for nonemergency ground ambulance transportation. For those services, insurers may still apply deductibles, coinsurance, and copayments, but if the ambulance provider is out of network, the insurer cannot charge the insured more than 110% of the cost-sharing that would apply for an in-network nonemergency ground ambulance provider. The bill applies to insurance contracts issued, renewed, or amended on or after October 1, 2025, and it also adds the new nonemergency ambulance coverage rule to the State Health Plan.
In addition to the coverage changes, the bill appropriates $1 million in recurring General Fund money for each year of the 2025-2027 biennium to the Department of State Treasurer to help pay for the added coverage under the act. The State Health Plan changes would take effect at the start of the next plan year after the relevant effective date.
The overall sentiment reflected by the bill text is consumer-protective and aimed at reducing surprise billing for ambulance services. Although there are no recorded committee transcripts or votes in the provided materials, the bill’s sponsors and title indicate support for making ambulance billing more equitable and predictable for insured patients. The measure appears designed to address a common gap in surprise-billing protections, especially where patients have little or no control over which ambulance provider responds.
The main point of potential contention is cost and insurer liability. The bill shifts more financial responsibility to insurers by limiting what they can charge patients for out-of-network ambulance services and by requiring recurring state funding for the State Health Plan. Another likely issue is the 110% cap for nonemergency out-of-network ground ambulance cost-sharing, which may draw debate over whether it is sufficient to protect patients while still allowing insurers and plans to manage costs.
The bill would amend Chapter 58 of the North Carolina General Statutes to expand and clarify insurance coverage for emergency ambulance services and to create a new statutory standard for nonemergency ground ambulance transportation. It would also amend the State Health Plan statute so that the new nonemergency ambulance coverage rule applies to the plan, and it appropriates recurring General Fund money to support the added coverage. The practical effect is to limit surprise billing exposure for insured patients, especially when ambulance providers are out of network, while imposing new coverage and disclosure obligations on insurers and the State Health Plan.
The bill’s apparent sentiment is broadly favorable toward consumers and patients, with a focus on fairness, transparency, and reducing surprise medical bills for ambulance transport. Because no committee transcripts or votes were provided, there is no recorded floor or committee debate to measure directly, but the bill’s framing and sponsor list suggest support for stronger patient protections. The policy direction is consistent with a bipartisan-style consumer protection approach, though the fiscal implications may generate scrutiny.
The likely points of contention are the financial impact on insurers, health plans, and the State Health Plan, as well as whether the bill’s reimbursement and cost-sharing limits are set at the right level. Insurers may object to being required to cover out-of-network emergency ambulance services without higher patient cost-sharing, and plan administrators may question the recurring appropriation needed to fund the mandate. Another possible dispute is the treatment of nonemergency ground ambulance services, where the bill allows cost-sharing but caps out-of-network charges at 110% of in-network cost-sharing, a standard that could be viewed as either too restrictive or not protective enough depending on the stakeholder.