This bill amends the Code of West Virginia to address surprise billing practices related to out-of-network ambulance services. Effective January 1, 2026, it mandates that health insurance policies must consider payments made by insurers to nonparticipating emergency medical services agencies as full payment for covered ground ambulance services, excluding any copayments, coinsurance, or deductibles. Additionally, these agencies are prohibited from billing the insured for any amounts beyond what the insurer pays. The bill establishes a payment rate for insurers at 400% of the current published rate set by the Centers for Medicare and Medicaid Services or the agency's billed charges, whichever is lower.

The legislation also outlines specific procedures for insurers regarding claims payments. Insurers are required to remit payment directly to nonparticipating emergency medical services agencies within 30 days of receiving a clean claim and must either pay or deny claims within the same timeframe, with certain exceptions. In cases of claim denial, insurers must provide written notice explaining the reasons for the denial or any additional information needed to process the claim. Overall, this bill aims to protect consumers from unexpected medical bills related to emergency ambulance services while ensuring timely and fair compensation for service providers.

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