Oklahoma passes one of the toughest ambulance billing laws in the country

New law rewrites ambulance billing rules

Oklahoma changed the way health insurers pay out-of-network ambulance providers on Jan. 1, 2026. Senate Bill 1067 overhauls the state’s ambulance reimbursement system and creates a public database of ambulance rates.

Sen. Paul Rosino and Rep. Preston Stinson wrote the bill, which passed the state Senate 32-13 and the House 87-6 in May 2025. The law updates the Out-of-Network Ambulance Service Provider Act, first created in 2024.

Providers can now post their rates

Here’s how it works. Local governments and ambulance providers can submit their service rates to the Oklahoma Insurance Department (OID) each year by Dec. 31. Submitting is voluntary, not required.

The OID had to build and maintain a public database of those rates on its website by Jan. 1, 2026. That database lets insurers and the public see what ambulance services actually charge.

But this isn’t a tool for patients to comparison shop. It’s mainly about setting the rules for how insurers reimburse providers.

Reimbursement depends on who submits rates

The math matters here. Providers who submit their locally approved rates get reimbursed at those rates as set or approved on May 1, 2025. Providers who don’t submit?

Insurers pay them the lesser of 325% of the current Medicare rate or the provider’s billed charges. The original 2024 law had set a flat minimum at 325% of Medicare for everyone.

Lawmakers debated dropping the cap to 275% during the session, but the final version kept 325% as the default.

Patients won’t get surprise ambulance bills

The biggest protection for everyday Oklahomans: ambulance providers can’t bill patients for anything beyond what insurance covers. You’re only on the hook for your standard copay, coinsurance, and deductible.

Out-of-network cost-sharing can’t exceed what you’d pay for in-network services. These protections apply to ground ambulance services across the state.

Federal law left ground ambulances uncovered

The federal No Surprises Act has protected patients from surprise emergency room and air ambulance bills since January 2022. But it left a gap: ground ambulance billing.

Oklahoma’s SB 1067 fills that hole at the state level.

Several other states have passed their own ground ambulance protections because the federal government hasn’t acted. Oklahoma now joins that growing list of states taking matters into their own hands.

Supporters say the old law cost families more

Sen. Rosino argued the 2024 law raised Oklahomans’ health plan costs by about $3 to $5 per month.

Oklahoma Families for Affordable Healthcare backed the bill, saying the old reimbursement rates sat far above market norms. Rosino said the public database would show insurers what local rates actually look like.

Supporters framed the law as a balance: fair pay for ambulance providers on one side, affordable premiums for Oklahoma families on the other.

Rural EMS leaders warned of closures

Not everyone is on board. The Oklahoma Ambulance Association (OKAMA) opposed the bill during the 2025 session.

OKAMA said at least 10 ambulance providers in the state had already closed or cut back services before SB 1067 even passed.

Robin Robinson, OKAMA vice president and director of McClain-Grady County EMS, said the law could cost her agency the equivalent of a full-time paramedic position.

She warned that rural providers, already financially stretched, could shut down entirely.

Response times could climb in rural areas

Robinson said without enough staff, her agency would need to call mutual aid ambulances, adding 15 to 25 minutes to response times.

EMSA revenue cycle director Sonia Coleman warned that if rural providers close, patients could wait hours for an ambulance or drive themselves to get care.

Dr. Bill Worden, who oversees about 150 EMS agencies across 60 Oklahoma counties, said many rural departments already run on razor-thin margins.

A July 2025 report in the AMA Journal of Ethics documented the same pattern nationally.

Rural EMS faces a nationwide crisis

Oklahoma’s fight isn’t happening in a vacuum. The AMA Journal of Ethics reported that rural EMS response times of 60 minutes aren’t uncommon in parts of the country.

From 2005 through 2024, 193 rural hospitals closed nationwide, making emergency access even harder.

“Ambulance deserts,” areas where EMS is sometimes completely unavailable, are spreading as volunteer staffing models break down.

Oklahoma’s debate over SB 1067 mirrors a national tension: controlling healthcare costs while keeping emergency services alive.

The law expires in two years

SB 1067 isn’t permanent. The rate structure automatically expires on Dec. 31, 2027, unless lawmakers act to extend or change it.

The Insurance Department must review data from the rate database and send a report to the Governor and legislative leaders by Jan. 1, 2027.

That gives lawmakers about two years of real data before they decide what comes next. A new bill, SB 167, was already filed in the 2026 session and appears to address the same reimbursement framework.

What Oklahoma residents need to know now

If you ride in an ambulance in Oklahoma, you can’t be billed beyond your normal copay and deductible, whether the provider is in-network or not.

The OID’s website now lists an “Ambulance Rate Reporting” section, though not every provider may appear since submitting rates is voluntary.

Oklahomans with questions can call the Oklahoma Insurance Department at 800-522-0071.

The law is active now, and its effects on both insurance costs and rural emergency services are just starting to play out.

Lawmakers face a deadline in 2027

Oklahoma now joins a growing group of states trying to balance ambulance provider pay with protections for patients. The 2027 sunset date means this is a trial run, not a permanent fix.

How well SB 1067 works will depend on how many providers submit their rates and what the data shows. The Insurance Department’s 2027 report will give lawmakers the information they need to decide the law’s future.

For now, the clock is ticking.

This article was created with AI assistance and human editing.

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