HB961: HB961 Surprise Billing Consumer Protection Act; insurance coverage for certain out-of-network ambulance transportation service; provide

Georgia's Surprise Billing Consumer Protection Act (O.C.G.A. Chapter 20E of Title 33) already addresses some surprise medical bills, but this bill rewrites the section covering ground ambulance transportation. It requires health plans to treat emergency ambulance rides as a covered service when requested by a first responder, a treating healthcare practitioner, or when medical necessity exists. The bill sets a minimum payment amount insurers must pay out-of-network ambulance providers: whatever rate a local government or authority has agreed to by contract or ordinance, or if none exists, 300 percent of the Medicare reimbursement rate for ambulance services. It caps patient copayments, coinsurance, and deductibles at what they would pay for an in-network ambulance provider, and requires insurers to pay ambulance providers directly (not patients) within 30 days of a clean claim, or send notice explaining any denial or request for more information.

• Requires health plans to cover emergency ground ambulance transport as a covered service when requested by a first responder, treating practitioner, or due to medical necessity.
• Sets a minimum reimbursement rate for out-of-network ambulance providers based on local government agreements, or 300 percent of Medicare's rate if no local agreement exists.
• Caps what patients pay in copayments, coinsurance, or deductibles for out-of-network ambulance service at the same level charged for in-network service.
• Requires insurers to pay ambulance providers directly within 30 days of a clean claim rather than sending payment to the patient.
• Requires insurers that receive an incomplete claim to notify the ambulance provider within 30 days, explaining any denial or listing what additional information is needed.

The bill affects Georgians who use emergency ground ambulance services, health insurers regulated under Georgia's surprise billing law, ambulance providers (including fire departments, counties, and private companies), and local governments that set ambulance reimbursement rates by contract or ordinance.

Patients who use an out-of-network ambulance during an emergency would be protected from paying more than they would for an in-network ambulance, and ambulance providers would get a guaranteed minimum payment and faster processing from insurers, changing how ambulance bills are handled statewide.

• Section 1 rewrites O.C.G.A. § 33-20E-23, defining terms like 'ambulance provider,' 'clean claim,' 'covered service,' 'emergency transport service,' 'first responder,' and 'medical necessity.'
• Subsection (b) requires health plans to treat emergency transport as covered when requested by a first responder or practitioner, or when medically necessary.
• Subsection (c) sets the minimum reimbursement rate: a local government-agreed rate, or absent that, 300 percent of the Medicare Part A or B ambulance reimbursement rate.
• Subsection (d) states that payment to the ambulance provider releases the patient from further payment except for copayments, coinsurance, or deductibles.
• Subsection (e) caps out-of-network ambulance copayments, coinsurance, or deductibles at the amount charged for in-network ambulance service.
• Subsection (f) requires insurers to pay clean claims directly to ambulance providers within 30 days, or send written notice of denial or requests for more information.
• Section 2 repeals conflicting laws.

1. 2026-03-06Senate Read and Referred (Senate)
2. 2026-03-04House Passed/Adopted By Substitute (House)
3. 2026-03-04House Third Readers (House)
4. 2026-02-24House Committee Favorably Reported By Substitute (House)
5. 2026-01-16House Second Readers (House)
6. 2026-01-15House First Readers (House)
7. 2026-01-14House Hopper (House)

• Alan Powell (R, HD-033)Primary sponsor
• Michelle Au (D, HD-050)
• Rick Jasperse (R, HD-011)
• Mary Oliver (D, HD-084)
• Sharon Cooper (R, HD-045)
• David Wilkerson (D, HD-038)

1. PassedHouse voteMarch 4, 2026

   174 yea, 1 nay (1 not voting, 1 absent)

   Passage: House Vote #611

• surprise medical billing
• ambulance services
• health insurance
• emergency medical services
• Georgia insurance law