OK| The Oklahoma Insurance Department has issued Bulletin No. 2025-11 introduces substantive legislative changes in Oklahoma for ambulance service reimbursement, impacting health insurers and ambulance service providers operating on behalf of local government entities effective January 1, 2026. The bill allows local government entities or their contracted ambulance service providers to annually submit approved service rates, and sets requirements for out-of-network reimbursement and cost-sharing limits for covered ambulance services.
Key issues:
- Local government entities or providers may submit approved ambulance service rates by December 31 each year; rates not submitted will default to the lesser of 325% of the published CMS rate or the provider’s billed charges.
- Health insurers must reimburse out-of-network ambulance services at rates set or approved as of May 1, 2025 if submitted, and enrollee cost-sharing for these services cannot exceed in-network cost-sharing amounts.