Minimum allowable reimbursement for ground ambulance services

(a) (1) The minimum allowable reimbursement rate under any health benefit plan issued by a healthcare insurer to a participating ground ambulance service provider or an out-of-network ground ambulance service provider shall be at the rates approved or contracted between an ambulance service provider and a local government entity as provided for in § 14-266-105 . (2) In the absence of rates set as provided under subdivision (a)(1) of this section, the minimum allowable rate of reimbursement under a health benefit plan issued by a healthcare insurer shall be the lesser of: (A) The rate established by the Workers' Compensation Commission under its medical fee schedule for ambulance services; or (B) The provider's billed charges. (b) A payment made under this section shall be considered payment in full for the covered services provided, except for any copayment, coinsurance, deductible, and other cost-sharing feature amounts required to be paid by the enrollee. (c) (1) A healthcare insurer shall remit payment within thirty (30) days for ambulance services directly to the ground ambulance service provider. (2) A healthcare insurer shall not send payment to an enrollee. Added by Act 2023, No. 597,§ 1, eff. 8/1/2023. (a) (1) The minimum allowable reimbursement rate under any health benefit plan issued by a healthcare insurer to a participating ground ambulance service provider or an out-of-network ground ambulance service provider shall be at the rates approved or contracted between an ambulance service provider and a local government entity as provided for in § 14-266-105 . (2) In the absence of rates set as provided under subdivision (a)(1) of this section, the minimum allowable rate of reimbursement under a health benefit plan issued by a healthcare insurer shall be the lesser of: (A) The rate established by the Workers' Compensation Commission under its medical fee schedule for ambulance services; or (B) The provider's billed charges. (1) The minimum allowable reimbursement rate under any health benefit plan issued by a healthcare insurer to a participating ground ambulance service provider or an out-of-network ground ambulance service provider shall be at the rates approved or contracted between an ambulance service provider and a local government entity as provided for in § 14-266-105 . (2) In the absence of rates set as provided under subdivision (a)(1) of this section, the minimum allowable rate of reimbursement under a health benefit plan issued by a healthcare insurer shall be the lesser of: (A) The rate established by the Workers' Compensation Commission under its medical fee schedule for ambulance services; or (B) The provider's billed charges. (A) The rate established by the Workers' Compensation Commission under its medical fee schedule for ambulance services; or (B) The provider's billed charges. (b) A payment made under this section shall be considered payment in full for the covered services provided, except for any copayment, coinsurance, deductible, and other cost-sharing feature amounts required to be paid by the enrollee. (c) (1) A healthcare insurer shall remit payment within thirty (30) days for ambulance services directly to the ground ambulance service provider. (2) A healthcare insurer shall not send payment to an enrollee. (1) A healthcare insurer shall remit payment within thirty (30) days for ambulance services directly to the ground ambulance service provider. (2) A healthcare insurer shall not send payment to an enrollee. Added by Act 2023, No. 597,§ 1, eff. 8/1/2023.