North Dakota Code § 26.1-47-12

Ambulance insurance coverage - Direct payment required - Determination
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of reimbursement rate for out-of-network ambulance service providers.
1. As used in this section:
a. "Ambulance service provider" means a service entity licensed under chapter 
23-27 as a basic life support or advanced life support ambulance service. The 
term does not include an air ambulance provider.
b. "Covered person" means an individual eligible to receive coverage of covered 
services by a health care insurer under a health benefit plan.
c. "Covered services" means medically necessary patient care or transportation 
provided by ambulance service providers.
d. "Health care insurer" means an entity subject to state insurance regulation that 
provides health benefit coverage in this state. The term includes:
(1) An insurance company;

(2) A health maintenance organization;
(3) A hospital or medical service corporation; and
(4) A risk-based provider organization.
e. "Medicare reimbursement rate" means the reimbursement rate for a particular 
health care service provided under the Health Insurance for the Aged and 
Disabled Act, title XVIII of the federal Social Security Act of 1965 [42 U.S.C. 
1395 et seq.], as amended.
2. All reimbursements made by a health care insurer for the provision of ambulance 
services to a covered person must be paid directly to the ambulance service provider 
or the provider's designee.
3. If a covered person receives ambulance services from an out -of-network ambulance 
service provider, the health care insurer shall pay the ambulance service provider the 
lesser of:
a. Two hundred fifty percent of the Medicare reimbursement rate for the same 
service in the same geographic area; or
b. The ambulance provider's billed charges.
4. Any rate the health care insurer pays under this section may not be required to include 
the coinsurance, copayment, and deductible owed or already paid by the covered 
person.
5. The insurance commissioner may adopt rules to implement and enforce this section.

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