Bill > SB645

This bill aims to prevent "surprise billing" for ground emergency medical services by non-participating providers, meaning situations where a patient receives emergency care from an ambulance service that is not in their insurance network and is then billed for the difference between the provider's charge and what the insurance paid. Starting January 1, 2027, for health insurance policies, insurers will be required to pay non-participating ground ambulance services directly, considering this payment as full for the service except for the patient's usual copayments, coinsurance, and deductibles. The payment rate will be either 200% of the Medicare rate for similar services or the ambulance agency's billed charges, whichever is less. Importantly, patients will not be billed for any additional amount beyond their standard cost-sharing. Insurers must process "clean claims" (complete and accurate claims) within 30 days and provide a written explanation if a claim is denied, detailing the specific reasons for denial or requesting necessary additional information. This legislation applies to various types of health insurance policies, including those from hospital service corporations, medical service corporations, and health maintenance organizations (HMOs), but excludes insurers contracted with the Bureau for Medical Services for Medicaid or CHIP.

Health and Social Services

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