The proposed bill amends the Code of West Virginia to address surprise billing for out-of-network ambulance services, set to take effect on 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, deductibles, or other cost-sharing amounts 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 of 400% of the current published rate for ambulance services as set by the Centers for Medicare and Medicaid Services or the agency's billed charges, whichever is lower.

Furthermore, the bill outlines specific procedures for insurers regarding the payment of claims. Insurers must remit payment directly to the nonparticipating emergency medical services agency within 30 days of receiving a clean claim and must either pay or deny the claim within the same timeframe, with certain exceptions. If a claim is denied, insurers are required to provide written notice detailing the reasons for denial or indicating if additional information is needed. Overall, this legislation 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