Landmark ambulance coverage legislation passes Illinois legislature, awaits Governor's signature

Bill shields patients from unfair insurance underpayments for necessary ground ambulance services

SPRINGFIELD, Ill., June 17, 2025 /PRNewswire/ -- In a major victory for Illinois patients and first responders, legislation addressing inadequate insurance payments for medically necessary ground ambulance service is now headed to Gov. J.B. Pritzker's desk. The bill passed both the House and Senate unanimously.

The bill, sponsored by Sen. Ram Villivalam, D-Chicago, and Rep. Marty Moylan, D-Des Plaines, protects consumers from the financial stress of being responsible for the cost of ground ambulance services when insurance providers refuse to pay the full cost of those services.

"This is a consumer protection bill that follows federal recommendations and protects patients from unexpected costs for utilizing ground ambulance services," said Kim Godden, President of the Illinois State Ambulance Association Board of Directors. "We have been working closely with stakeholders for nearly three years to find common ground on providing a solution to a problem that impacts patients at their most vulnerable moments and jeopardizes reliable ambulance transportation throughout the state. With this legislation, ambulance providers will receive the reimbursement necessary to maintain operations and patients' insurance will provide coverage so patients will no longer be in the middle regarding the ambulance bill."

The legislation (House Bill 2785): 

• Requires insurance coverage for all emergency and urgent ground ambulance services (ordered within 12 hours).
• Caps patient costs at the lower of an ER visit copay or 10% of the recognized amount for ground ambulance services provided to prevent excessive out-of-pocket expenses.
• Bans balance billing when ground ambulance service providers accept a defined, fair payment amount.
• Mandates insurer payment equal to the lesser of: (1) negotiated rate, (2) 85% of billed charges, or (3) average gross charge amount for a previous one-year period.
• Protects ground ambulance service providers from arbitrary insurer rates and helps Illinois' first responders, municipalities and fire protection districts recoup fair reimbursement for 911 transports from commercial insurance providers, which reduces the burden on taxpayer dollars currently subsidizing these lifesaving services.
• Protects patient access to emergency ground ambulance services and urgent ground ambulance service throughout Illinois through consistent and fair rate-setting and payment by health insurance issuers.

The effective date of the legislation, once signed into law, is Jan. 1, 2027, giving all stakeholders time to prepare for implementation.

"This is an especially important bill for downstate and rural Illinois where ground ambulance services are often a primary source of health care," said Andrew Thornton, Treasurer of the Illinois State Ambulance Association. "As ground ambulance service providers, we never want our patients to have to worry about billing or make a decision based on cost when they face an emergency. We're grateful for all of our partners who came to the table and negotiated a solution in good faith for the betterment of our patients."

"When you call for an ambulance, your first concern should not be how much it will cost and if it is covered by your insurance, it should be getting the help you need. Many are facing surprise bills after being transported by ambulance, placing an undue burden upon insured residents and even causing some to avoid calling 911 out of fear of what services will cost," Sen. Villivalam said. "That's why I am proud to sponsor and pass House Bill 2785 through the Senate as it will prevent our insured residents from unexpected large bills when seeking the care they need."

"As a former mayor, I am familiar with the importance of 911 EMS Ambulance transportation," Rep. Moylan said. "This legislation ensures that municipalities, fire protection districts and first responders throughout Illinois receive fair and adequate reimbursement for these services without patients being financially responsible or taxpayers subsidizing inadequate reimbursement. When a resident calls 911, they expect (and need) fast, reliable, quality care. This legislation allows for that to occur."

The federal No Surprises Act, enacted in 2020, prohibited balance billing for emergency healthcare services but excluded ground ambulance services due to the unique nature of these services. Unlike hospitals or physicians, ground ambulance services are locally regulated and lack the negotiating power to secure "in-network" status with insurers.

To address the gap, Congress established the Advisory Committee on Ground Ambulance and Patient Billing, which delivered its recommendations to Congress in Fall 2024. Among those recommendations, states were urged to enact their own laws to protect patients and support ground ambulance service providers. This legislation aligns with federal guidance, protects patients from unfair insurance underpayments, ensures ground ambulance providers are provided fair and timely payment for their often life-saving services, and protects patient access to these critically important services.

SOURCE Illinois State Ambulance Association