Bill > SB717

This bill prohibits surprise billing for ground ambulance services in West Virginia, protecting patients from unexpected medical charges when using out-of-network emergency medical services. Starting January 1, 2026, the bill requires insurers to pay nonparticipating emergency medical services agencies directly for ground ambulance services at either 400% of the Medicare rate or the agency's billed charges, whichever is less. The nonparticipating agency is forbidden from billing patients for any additional amount beyond their standard copayments, coinsurance, and deductibles. Importantly, these out-of-pocket costs cannot exceed what a patient would pay with a participating agency. The bill also mandates that insurers process clean claims within 30 days, either paying or providing a detailed explanation for denial, and ensures that payment goes directly to the emergency medical services agency rather than to the patient. This 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, and aims to protect patients from financially burdensome surprise medical bills during emergency situations.