The proposed bill amends the Code of West Virginia to address surprise billing practices specifically for out-of-network ambulance services. Effective January 1, 2026, the bill 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, nonparticipating providers are prohibited from billing the insured for any amounts beyond what the insurer pays. The bill also establishes that insurers must pay nonparticipating agencies at a rate of either 400% of the current Medicare rate for similar services in the same geographic area or according to the agency's billed charges, whichever is lower.

To ensure timely payment, the bill requires insurers to remit payment for clean claims directly to nonparticipating emergency medical services agencies within 30 days of receipt and prohibits sending payment to the covered individual. Insurers must either pay or deny claims within the same timeframe, with exceptions for claims involving other payors or fraudulent submissions. In the event of a claim denial, insurers are obligated to provide written notice detailing the reasons for the denial or indicating if further information is needed. Overall, the bill aims to protect consumers from unexpected medical bills related to emergency ambulance services while ensuring fair and timely compensation for service providers.

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