Alabama (Alabama) does not have a comprehensive, pre-existing surprise billing statute that sets its own out-of-network (OON) payment benchmark or operates a state-run arbitration system like Maine or Arizona.

Instead, Alabama primarily relies on:

• General state insurance and consumer-protection laws; and
• The federal No Surprises Act (NSA), which became effective for plan years beginning on or after January 1, 2022, and now serves as the controlling surprise billing framework for most commercial plans in the state.

Alabama is treated by CMS as a “Federal IDR Process” state (not bifurcated and with no Specified State Law/All-Payer Model).

Because Alabama lacks a standalone surprise billing law with its own payment rules, “Alabama SBL” for all practical MedRev purposes = Alabama enforcement + federal NSA.

Under Alabama’s use of the NSA framework, for NSA-protected services:

• Emergency services provided by OON providers or facilities must be covered on an in-network cost-sharing basis, and patients cannot be balance billed beyond in-network copays/coinsurance/deductibles.
• Non-emergency services furnished by OON providers at in-network hospitals or ASC-type facilities are also protected from balance billing, unless the federal notice-and-consent requirements are properly met.
• Plans must issue an initial payment or denial based on the plan’s recognized amount, which under NSA is typically the Qualified Payment Amount (QPA)—a median contracted rate for similar services in the geographic region.

Alabama does not impose an APCD-based benchmark, UCR formula, or state-specific payment floor; instead it adopts the federal QPA-centered methodology through the NSA.

Alabama does not operate a state-run IDR/arbitration system for surprise billing disputes and does not have a CMS-recognized Specified State Law (SSL) for OON rate determination.

As a result:

• All NSA-eligible OON payment disputes in Alabama use the Federal IDR process.
• This includes disputes over:
  
  • Emergency OON services
  • Non-emergency OON services at in-network facilities
  • OON air ambulance services
  • Any other claims falling under NSA where providers challenge the adequacy of the plan’s QPA-based payment

There is no alternate Alabama arbitration forum for these disputes.

Alabama follows the NSA’s required negotiation structure:

1. The plan issues an initial payment or denial.
2. A 30-day open negotiation window begins on the date the provider receives that initial payment or denial.
3. During those 30 days, the provider and plan must attempt to resolve the dispute informally.
4. If unresolved, either party may initiate a case through the Federal IDR portal, selecting a certified IDR entity to perform binding “baseball-style” arbitration.

Alabama does not add a separate state-level negotiation timeline or duplicate process; it uses the federal sequence as-is.

Because Alabama uses Federal IDR exclusively, the arbitrator applies the federal statutory criteria, including:

• Qualified Payment Amount (QPA)
  
  • The primary reference point, but not the only factor.
• Provider-related factors
  
  • Level of training, education, board certification, and experience
  • Quality and outcomes indicators where presented
• Case-specific factors
  
  • Patient acuity and the complexity of services
  • Facility characteristics (teaching, trauma level, rural/urban, etc.)
• Market factors
  
  • Relative market share of the provider or facility and the insurer in the geographic region
  • Previous contracted rates between the parties over the previous four years (excluding “incentive” outlier contracts created to influence arbitration)
• Good-faith contracting behavior
  
  • Evidence that one party refused to negotiate reasonably or attempted to game the system.

Alabama law does not create its own arbitration factors that would supersede or modify this federal test.

Alabama’s surprise-billing landscape rests on:

• The Alabama Department of Insurance (ALDOI) regulatory oversight of state-regulated health plans, including enforcement of federal consumer protections.
• General unfair trade practice and consumer protection statutes that can be used against egregious billing behavior.
• The federal No Surprises Act and implementing regulations under 45 CFR 149.510 & 149.520, which govern:
  
  • Balance billing prohibitions
  • QPA methodology
  • Required disclosures and EOB language
  • The negotiation + Federal IDR process

Crucially, Alabama has not enacted a separate, detailed SBL with its own OON pricing rules or state arbitration process—so there is no “Alabama benchmark” to navigate; it’s all NSA-driven.

From CMS’s perspective, Alabama is a straight Federal IDR state:

• No Specified State Law (SSL) for setting OON rates.
• No All-Payer Model Agreement (APMA).
• Therefore, NSA & Federal IDR govern OON payment determinations for all NSA-eligible services across:
  
  • Fully insured commercial plans
  • Individual and small-group plans
  • Large-group plans
  • Self-funded ERISA plans (unless they adopt some other state SSL, which is extremely rare and not Alabama-specific).

• QPA controls the initial payment amount.
• All arbitration flows through the Federal IDR portal.
• Alabama state law shapes enforcement and consumer-facing rights, but does not change the payment mechanics.

Alabama is not bifurcated; it’s a classic “NSA-only” jurisdiction from a reimbursement standpoint.