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 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. Additionally, nonparticipating providers are prohibited from billing the insured for any amounts beyond what the insurer requires them to pay. The bill also mandates that insurers remit payment directly to these agencies within 30 days of receiving a clean claim and outlines the procedures for claim denial, requiring written notice to the insured.

Furthermore, the bill aims to protect individuals from balance billing by ensuring that the cost-sharing amounts for out-of-network emergency medical services do not exceed those applicable if the services were provided by a participating agency. Insurers are required to pay non-participating emergency medical services 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. Overall, the legislation seeks to ensure timely and fair compensation for emergency medical services while safeguarding consumers from unexpected costs associated with out-of-network billing.

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