Bill > HB3470

This bill prohibits surprise billing for ground emergency medical services by nonparticipating providers in West Virginia, effective January 1, 2026. The legislation applies to various types of health insurance policies and prevents nonparticipating emergency medical services agencies from balance billing patients for ground ambulance services. Insurers are required to pay these agencies directly at a rate of either 400% of the current Medicare published rate for the same ambulance service in the same geographic area or the agency's billed charges, whichever is less. The bill ensures that patients will not pay more in copayments, coinsurance, deductibles, or other cost-sharing amounts than they would if the ambulance service was provided by a participating agency. Insurers must process clean claims within 30 days, paying the nonparticipating emergency medical services agency directly, and provide written explanation if a claim is denied. The law includes specific exceptions for claim denials, such as when another payor is responsible or the claim was submitted fraudulently, and aims to protect patients from unexpected and potentially high medical bills resulting from out-of-network emergency medical services.