House Bill 489 would require health benefit plans in North Carolina to pay a minimum reimbursement rate for emergency ambulance transportation services provided by out-of-network ambulance providers. The bill amends the state’s emergency care coverage statute to clarify that emergency services include ambulance transportation and related emergency medical transportation, including interfacility transports and certain emergency medical evaluations that do not result in transport.
For out-of-network ambulance services, the bill sets a floor for reimbursement. If a local government has set or approved an ambulance rate in the jurisdiction where the service originated, the insurer must pay 100% of that rate. If no local rate exists, the minimum payment is the lesser of 400% of the most recent published Medicare rate for the same service in the same geographic area or the provider’s billed charges. The bill also requires insurers to pay ambulance providers directly, treats compliant payment as payment in full for covered services, and limits what cost-sharing may be charged to the covered person.
The bill would revise G.S. 58-3-190, North Carolina’s emergency care coverage statute, to add specific reimbursement rules for emergency ambulance transportation and to bar insurers from imposing higher cost-sharing for emergency transportation than the bill allows. It also repeals two existing definitions in the statute and replaces them with updated definitions for emergency medical transportation and related terms. The measure applies to insurance contracts issued, renewed, or amended on or after October 1, 2025, and to ambulance services provided on or after that date, while preserving the option for self-funded ERISA plans to opt in.
The available legislative record shows no committee transcript and no recorded votes, so there is no direct evidence of debate or floor sentiment in the materials provided. Based on the bill’s structure, it appears designed to address surprise billing and reimbursement disputes for emergency ambulance services, suggesting a consumer-protection and provider-payment focus rather than a partisan policy overhaul. The bill advanced at least to referral in the Senate after receiving a favorable committee substitute in the House.
The main policy tension is between insurers and ambulance providers over how much out-of-network emergency transport should be reimbursed and how much of that cost may be passed on to patients. Insurers may view the mandated minimum reimbursement and direct-payment requirements as increasing claims costs, while ambulance providers and patient advocates are likely to support the bill as a way to ensure payment and reduce unexpected balance billing. Another possible point of contention is the use of Medicare-based benchmarks and local government-set rates, which may be seen as either a reasonable floor or an administratively complex pricing formula.