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AlabamaSB2692026 Regular SessionSenateWALLET

Ground ambulance services; to prohibit balance billing and set minimum reimbursement rates by health care insurers to emergency medical service providers

Sponsored By: Bobby D. Singleton (Democratic)

Enacted

Insurance

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Bill Overview

Analyzed Economic Effects

4 provisions identified: 2 benefits, 1 costs, 1 mixed.

Patients get protection from extra ambulance bills

Beginning October 1, 2026, covered ambulance services cannot cost you more than your plan’s in-network cost-sharing amount. This applies to plans subject to this law, whether the provider is in or out of network. Payments under the law count as payment in full; providers and their billing agents cannot collect extra charges. Insurers must confirm your cost-sharing amount when an out-of-network provider requests it. Insurers must also offer willing, properly licensed ambulance providers contracts on terms comparable to similar in-network providers. These protections and contracting rules expire June 1, 2029, unless renewed or amended.

Insurers must pay ambulance providers promptly

Beginning October 1, 2026, insurers must pay out-of-network ambulance providers directly, not send payments to patients. For covered services, complete electronic claims require payment within 30 days; complete written claims require payment within 45 days. For incomplete claims, insurers must acknowledge receipt in writing within 30 days and explain the denial or missing information. Insurers cannot demand data beyond standard claim forms for initial processing. Providers can use the insurer’s dispute process, then seek independent review through a contractor both sides agree on. These rules expire June 1, 2029, unless renewed or amended.

Three insurers fund ambulance cost study

The Alabama Association of Ambulance Services must hire a regional business school to study the law’s effects on ambulance services and costs. The school must award doctoral degrees and hold accreditation from the Association to Advance Collegiate Schools of Business. The study must compare other states’ approaches and recommend ways to balance access with costs for Alabama, employers, and residents. The contract cannot exceed $50,000, funded by Alabama’s three largest insurers by state enrollment that offer individual Marketplace plans. The report is due to legislative leaders by December 1, 2028.

Higher ambulance payments with billing limits

Beginning October 1, 2026, insurers must pay in-network providers at least 200% of Medicare’s rate for covered emergency ground transports. Beginning January 1, 2027, in-network treatment without transport has a 200% minimum based on Medicare’s basic-life-support rate. Out-of-network emergency ground transports have a 180% minimum starting January 1, 2027; the treatment-without-transport minimum does not apply outside the network. Statewide payments use Medicare’s ambulance fee schedule for ZIP code 35462, including base and mileage amounts. Providers cannot submit a treatment-without-transport claim after submitting an emergency transport claim for the same event. These rules expire June 1, 2029, unless renewed or amended.

Sponsors & Cosponsors

Sponsor

  • Bobby D. Singleton

    Democratic • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 282 • No: 5

House vote • 3/31/2026

Third Reading in Second House

Yes: 102 • No: 0 • Other: 1

House vote • 3/31/2026

Motion to Read a Third Time and Pass - Adopted Roll Call 1066

Yes: 103 • No: 0 • Other: 1

Senate vote • 3/3/2026

Singleton motion to Adopt - Adopted Roll Call 682

Yes: 25 • No: 1 • Other: 1

Senate vote • 3/3/2026

Third Reading in House of Origin

Yes: 25 • No: 2 • Other: 1

Senate vote • 3/3/2026

Motion to Read a Third Time and Pass as Amended - Adopted Roll Call 683

Yes: 27 • No: 2 • Other: 1

Actions Timeline

  1. Enacted

    4/6/2026Senate

  2. Third Reading in Second House

    3/31/2026House

  3. Motion to Read a Third Time and Pass - Adopted Roll Call 1066

    3/31/2026House

  4. Ready to Enroll

    3/31/2026Senate

  5. Enrolled

    3/31/2026Senate

  6. Signature Requested

    3/31/2026House

  7. Delivered to Governor

    3/31/2026Senate

  8. Reported Out of Committee Second House

    3/17/2026House

  9. Read for the Second Time and placed on the Calendar

    3/17/2026House

  10. Read for the first time and referred to the House Committee on Insurance

    3/5/2026House

  11. Pending Committee Action in Second House

    3/5/2026House

  12. Third Reading in House of Origin

    3/3/2026Senate

  13. Banking and Insurance 1st Substitute Offered

    3/3/2026Senate

  14. Singleton motion to Adopt - Adopted Roll Call 682

    3/3/2026Senate

  15. Motion to Read a Third Time and Pass as Amended - Adopted Roll Call 683

    3/3/2026Senate

  16. Engrossed

    3/3/2026Senate

  17. Banking and Insurance 1st Substitute

    2/26/2026Senate

  18. Reported Out of Committee House of Origin

    2/26/2026Senate

  19. Read for the Second Time and placed on the Calendar

    2/26/2026Senate

  20. Read for the first time and referred to the Senate Committee on Banking and Insurance

    2/5/2026Senate

  21. Pending Committee Action in House of Origin

    2/5/2026Senate

Bill Text

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