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Read. Follow. Verify.North Carolina Sets Minimum Insurance Payouts for Out-of-Network Ambulances and Caps Patient Copays
Last action · May 7, 2025: Ref To Com On Rules and Operations of the Senate (Senate action)Sponsors: Donnie Loftis and 16 others
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What This Bill Would Do
North Carolina requires health insurers to pay out-of-network emergency ambulance providers at least local government-approved rates or 400% of the Medicare rate, while capping patient cost-sharing at $100 or 10% of the reimbursement rate starting October 1, 2025.
Insured residents using out-of-network ambulances are shielded from unlimited balance billing while insurers face mandatory minimum payout floors.
- Emergency medical transportation out-of-network billing has historically been a significant source of surprise medical bills for insured consumers. context
Who It Would Affect
Groups the bill's text would affect if enacted, as described in the record. Being affected is not a position for or against it.
Out-of-network ambulance service providers
Receive guaranteed minimum reimbursement rates from insurers and direct payments for emergency transportation services.
Covered persons enrolled in health benefit plans
Have their out-of-network emergency ambulance cost-sharing capped at the lesser of $100 or 10% of the reimbursement rate and are protected from receiving insurer reimbursement checks.
Health insurers
Must pay out-of-network ambulance providers at prescribed statutory minimum rates and remit payments directly to providers.
Key Facts
You don't have to trust us. Each fact below is taken straight from the official document - click any one to see the exact passage, highlighted in the original.
Frequently Asked Questions
What is the maximum amount an insurer can charge a patient for out-of-network emergency ambulance transportation?
Who receives the payment from the insurer for out-of-network emergency ambulance services?
What else do you want to know?
News Coverage
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Votes, people, money & the original sourceWhere This Stands
Currently passed chamber. The next step in the legislative lifecycle is Law.
Procedural history
17 actions- May 7, 2025SenateRef To Com On Rules and Operations of the Senate
- May 7, 2025SenatePassed 1st Reading
- May 7, 2025SenateRegular Message Received From House
- May 7, 2025HouseRegular Message Sent To Senate
- May 6, 2025HousePassed 3rd Reading
- May 6, 2025HousePassed 2nd Reading
Show 11 earlier actions
- May 5, 2025HousePlaced On Cal For 05/06/2025
- May 5, 2025HouseCal Pursuant Rule 36(b)
- May 5, 2025HouseReptd Fav
- Apr 30, 2025HouseRe-ref Com On Rules, Calendar, and Operations of the House
- Apr 30, 2025HouseReptd Fav
- Apr 29, 2025HouseRe-ref Com On Insurance
- Apr 29, 2025HouseReptd Fav Com Substitute
- Apr 17, 2025HouseSerial Referral To Finance Stricken
- Mar 25, 2025HouseRef to the Com on Health, if favorable, Insurance, if favorable, Finance, if favorable, Rules, Calendar, and Operations of the House
- Mar 25, 2025HousePassed 1st Reading
- Mar 24, 2025HouseIntroducedFiled
Version history
Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.
View official text →Lobbying Activity
No state lobbying filings in our records match this bill. Federal lobbying reports (LDA) cover Congress, so they are not listed on state bills.
Full breakdown
Who this bill affects and the strongest case for and against it, written only from the bill’s own text.
Sponsors
Show 12 more sponsors
Discoveries
Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.
Mandatory Direct-to-Provider Reimbursement
Insurers are explicitly barred from sending reimbursement payments for emergency transportation to covered persons, requiring direct payment to out-of-network providers.
Connected Entities
Sources
www.ncleg.gov
Analysis Score
0–100- Significance75How much this matters to a regular citizen
- Controversy50Intensity of disagreement among stakeholders
- Entertainment10Compellingness for a non-policy-wonk reader
- Buzz35Current news / social attention level
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