The proposed bill seeks to amend the Code of West Virginia by introducing new regulations to address surprise billing for out-of-network ambulance services. Effective January 1, 2027, health insurance policies will require insurers to treat payments made to non-participating emergency medical services agencies as full payment for covered ground ambulance services, excluding any copayments, coinsurance, deductibles, or other cost-sharing amounts. Furthermore, non-participating providers are prohibited from billing insured individuals for any additional amounts beyond these required payments. Insurers are mandated to pay these agencies directly 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.

The bill also establishes specific payment procedures for insurers, requiring them to remit payment for clean claims within 30 days and to either pay or deny claims within the same timeframe, with certain exceptions. In the event of a claim denial, insurers must provide written notice detailing the reasons for the denial or indicating if further information is needed. Notably, these provisions do not apply to insurers contracted with the Bureau for Medical Services regarding Medicaid or CHIP. Overall, the bill 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