HB 3470
Prohibiting surprise billing of ground emergency medical services by nonparticipating providers
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Sign in to take action- Introduced
- Passed House of Delegates
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill prohibits surprise billing for ground emergency medical services provided by out-of-network ambulance services to covered individuals in West Virginia. It requires insurers to pay nonparticipating ambulance agencies at 400% of the Medicare rate or their billed charges, whichever is lower, and limits the amount a patient is required to pay to the copay, coinsurance, or deductible they would normally pay. The bill also establishes a payment timeline for insurers and mandates written notices for denied claims, with exceptions for coordinated benefits or fraudulent claims.
Key provisions
- Requires insurers to pay nonparticipating ambulance agencies at 400% of the Medicare rate or billed charges (whichever is lower).
- Limits patient cost-sharing to their usual copay, coinsurance, or deductible.
- Establishes a 30-day payment deadline for insurers to remit payment to ambulance agencies.
- Requires insurers to provide written notice when a claim is denied, detailing the reason for denial.
- Prohibits ambulance agencies from billing patients for additional costs beyond cost-sharing amounts.
- Specifies that payment to the ambulance agency should be direct, not to the patient.
- Excludes air ambulance services from the scope of this bill.
- Requires insurers to either pay or deny a claim within 30 days.
Who is affected
- Health insurance policyholders in West Virginia
- Emergency medical services agencies (both participating and nonparticipating)
- Insurers operating in West Virginia
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