This legislation is expected to have a considerable impact on state laws governing health insurance and ambulance billing practices. It will require health carriers to reimburse nonparticipating ambulance service providers using a formula that includes a rate established by local authorities or a fixed percentage of Medicare rates. The move to prohibit balance billing intends to provide patients with clearer expectations regarding their financial responsibilities when receiving ambulance services, thus enhancing consumer protection within the healthcare system.
Summary
House Bill 725, introduced in the 2025 session, focuses on reforming the regulations surrounding ground ambulance services in New Hampshire. A key feature of the bill is the prohibition of balance billing for ambulance services under the managed care law. This is significant as balance billing often places a financial burden on patients who may receive unexpected charges after utilizing nonparticipating ambulance services. The bill seeks to establish more equitable billing practices by setting clear payment criteria for services provided by nonparticipating ambulance providers, ensuring patients are not subjected to exorbitant out-of-pocket expenses.
Contention
Despite the bill's intent to protect consumers, there may be points of contention among stakeholders. Concerns arise particularly around the potential increase in insurance premiums as a result of the mandated payment structures for ambulance services. Since the bill sets a minimum reimbursement standard of 325% of Medicare rates, critics argue that this could lead to upward pressures on health insurance costs that may ultimately burden consumers. Furthermore, ambulance service providers may have differing opinions regarding the reimbursement rates and the implications it has on their financial viability.
Implementation
If enacted, HB 725 will take effect on January 1, 2026, and will initiate a shift in how ambulance services are billed and compensated in New Hampshire. The legislation will require health carriers to streamline their processes for reimbursing ambulance providers, ensuring that reimbursements are paid directly to the service providers rather than through patients. This change aims to simplify the claims process and improve the sustainability of ambulance services in various localities across the state.
Relative to prohibiting insurance companies from conducting an audit of providers services after services have been delivered but before payment has been made to such provider.