This bill amends the Code of West Virginia to address surprise billing for out-of-network ambulance services, specifically for health insurance policies issued on or after January 1, 2026. It mandates that payments made by insurers to nonparticipating emergency medical services agencies for covered ground ambulance services will be considered full payment, excluding any copayments, coinsurance, or deductibles required from the insured. Additionally, nonparticipating providers are prohibited from billing the insured for any amounts beyond what the insurer requires. The bill establishes a payment rate for insurers at 400% of the current published rate for ambulance services as set by the Centers for Medicare and Medicaid Services or according to the agency's billed charges, whichever is lower.

The legislation also outlines the payment and claim denial procedures, requiring insurers to remit payment directly to nonparticipating emergency medical services agencies within 30 days of receiving a clean claim. Insurers must either pay or deny the claim within the same timeframe, with exceptions specified in the bill. If a claim is denied, insurers are obligated to provide written notice detailing the reasons for denial or indicating if additional information is needed. Overall, the bill aims to protect consumers from unexpected medical bills while ensuring timely payment to ambulance service providers.

Statutes affected:
Introduced Version: 33-15-24, 33-16-20, 33-24-46, 33-25-23, 33-25A-37