Bill > SB632

This bill addresses surprise billing for ground ambulance services in West Virginia by establishing new regulations for health insurance policies issued on or after January 1, 2026. The bill prevents nonparticipating emergency medical services agencies from billing patients for additional costs beyond their standard copayments, coinsurance, and deductibles. Insurers are required to pay nonparticipating ambulance services directly at a rate of 400 percent of the current Medicare rate for the same services in the same geographic area, or the agency's billed charges, whichever is less. The bill ensures that patients' out-of-pocket costs for out-of-network ground ambulance services will not exceed what they would pay for in-network services. Insurers must process clean claims within 30 days, either paying or providing a detailed written explanation for denial, with exceptions for cases involving other payors, coordinated benefits, previous payment, fraudulent claims, or material misrepresentations. The legislation applies to various types of health insurance policies, including group accident and sickness insurance, hospital service corporations, health care corporations, and health maintenance organizations, with a specific exemption for Medicaid and CHIP insurers.