Health insurance; ambulance service provider; providing for establishment of certain database; modifying reimbursement rates and criteria for certain ambulance services. Effective date.
Summary
SB1067 amends Oklahoma’s Out-of-Network Ambulance Service Provider Act to change how out-of-network ambulance claims are reimbursed under health care benefit plans. The bill allows local governmental entities, or ambulance providers acting on their behalf, to submit ambulance service rates to the Insurance Department annually, and it directs the Department to create and maintain a public database of those submitted rates by January 1, 2026.
The bill sets the minimum allowable reimbursement for covered out-of-network ambulance services at the local rate submitted for the jurisdiction where the service originates, if such a rate has been submitted. If no local rate is available, reimbursement defaults to the lesser of 325% of the applicable Medicare ambulance rate in the same geographic area or the provider’s billed charges. Payments made under the statute are treated as payment in full, except for normal patient cost-sharing, and ambulance providers may not balance bill enrollees for amounts above the insurer’s payment. The Department must also review the database and report to legislative leaders and the Governor by January 1, 2027, and the reimbursement provisions sunset unless the Legislature extends or modifies them before December 31, 2027.
Impact
The bill amends 36 O.S. Supp. 2024, Section 6050.3, expanding the state’s framework for ambulance reimbursement and adding new administrative duties for the Insurance Department. It affects health insurers, ambulance service providers, local governmental entities, and insured patients by establishing a public rate database, setting reimbursement floors for out-of-network ambulance services, limiting patient cost-sharing to in-network levels, and prohibiting additional billing beyond insurer payment. The measure takes effect January 1, 2026, and includes a temporary sunset for the reimbursement rates unless the Legislature acts again before the end of 2027.
Sentiment
The bill appears to have received generally favorable support, as reflected in its passage through both chambers with comfortable margins, including strong House and Senate floor votes. The vote history suggests broad agreement on the need to address ambulance reimbursement and out-of-network billing practices, likely to improve predictability for providers and consumers. The absence of committee transcript material limits insight into detailed debate, but the overall legislative pattern indicates the measure was viewed as a practical health insurance and emergency services policy fix.
Contention
The main points of contention likely centered on the reimbursement methodology and the balance between insurer costs and ambulance provider revenue. The bill’s use of local government-set rates, the fallback to 325% of Medicare, and the prohibition on balance billing could draw concern from insurers about higher claims costs, while ambulance providers may have sought stronger payment protections or clearer rate-setting rules. The sunset provision and required report suggest lawmakers wanted to monitor the policy’s effects before making it permanent, indicating some caution about the long-term impact of the new reimbursement structure.