This bill aims to amend the Code of West Virginia by introducing new sections that mandate insurers to directly pay out-of-network emergency medical services agencies for ground ambulance services. Specifically, it requires that insurers remit payment for clean claims within 30 days of receipt, ensuring that payments are made directly to the service providers rather than to the covered individuals. The bill outlines specific circumstances under which an insurer may delay payment, such as when another party is responsible for the claim or if there are issues of fraud or misrepresentation.

Additionally, if an insurer determines that a claim is not a clean claim, they are required to provide written notice within 30 days, detailing the reasons for declining payment or specifying what additional information is needed to process the claim. This legislation is designed to streamline the payment process for emergency medical services and ensure timely compensation for providers, thereby enhancing the overall efficiency of emergency medical care in West Virginia.

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