Bill > SB645

This bill, effective for health insurance policies issued on or after January 1, 2027, aims to prevent "surprise billing" for ground ambulance services by out-of-network providers. A "non-participating emergency medical services agency" refers to an ambulance service that does not have a contract with a patient's health insurance plan. The bill mandates that insurers pay these non-participating agencies directly for covered ground ambulance services, and the payment amount will be either 400% of the Medicare rate for similar services or the agency's billed charges, whichever is less. This payment is considered full for the service, meaning the ambulance agency cannot bill the patient for any amount beyond their standard copayment, coinsurance, deductible, or other cost-sharing obligations, which will be the same as if the service were provided by an in-network agency. Insurers are required to process "clean claims" (claims that are complete and accurate) within 30 days, either by paying or denying them with a specific reason, and they must send payment directly to the ambulance agency, not the patient. The bill also specifies exceptions for claim denial, such as if another party is responsible for payment or if the claim is fraudulent.

Health and Social Services

http://www.wvlegislature.gov/Bill_Status/Bills_history.cfm?input=645&year=2026&sessiontype=RS&btype=bill