Representative Steve Gist introduced House Bill 758 as a consumer‑protection and provider‑stability measure aimed at eliminating surprise ground‑ambulance balance billing. Proponents framed the bill as both a patient protection and a way to preserve rural emergency medical services.

Don Whalen, manager of Missoula Ambulance and president of the Montana Ambulance Association, told the committee: “No one should be worried about an unexpected bill when an emergency arises.” Whalen said HB 758 would protect patients by placing a $100 hard cap on patient out‑of‑pocket liability for commercially insured members and ensure providers receive payment either by contract, a local municipal or county rate, or — if no rate exists — a default of 400% of Medicare.

Sean Baird, former member of the federal Ground Ambulance Patient Billing Advisory Committee, testified the committee spent a year studying ground ambulance billing and recommended similar protections; he said ground ambulance represents a tiny fraction of insurer spending (the committee cited roughly 0.3% in national analyses), though an unexpected ambulance bill can average several hundred dollars and be significant for an individual patient. Proponents said several states have enacted comparable protections to preserve access and limit consumer liability.

Commercial insurers Blue Cross Blue Shield of Montana and Mountain Health Co‑op opposed the bill, warning the 400%‑of‑Medicare default could set a high price floor, increase insurer costs and premiums, and create a disincentive to contract. Drew Chuck of Blue Cross said the company had not seen balance‑billing complaints from members and that a guaranteed 400% default would encourage higher negotiated rates. The deputy insurance commissioner asked that statutory language be clarified on how “established local rates” would be set and maintained.

No committee vote was recorded that day; sponsors and opponents discussed effective dates and implementation timing. Proponents suggested the bill was modeled on federal advisory committee recommendations and similar statutes in other states.