The proposed 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 establishes 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, deductibles, or other cost-sharing amounts required from the insured. Furthermore, nonparticipating providers are prohibited from billing the insured for any additional amounts beyond what the insurer requires them to pay.

Additionally, the bill mandates that insurers must pay either 400% of the current published rate for ambulance services set by the Centers for Medicare and Medicaid Services or the agency's billed charges, whichever is lower. 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. If a claim is denied, insurers must provide written notice detailing the reasons for denial or indicating if further information is needed. Overall, the legislation aims to protect consumers from unexpected medical bills related to emergency ambulance services while ensuring timely payments to service providers.

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