SB 632
Relating to surprise billing of out-of-network ambulance services
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Sign in to take action- Introduced
- Passed Senate
- Passed House of Delegates
- To Governor
- Became Law
Bill overview
This bill aims to protect West Virginia residents from surprise medical bills when receiving ambulance services. Specifically, it prohibits ambulance services from billing patients or insurers for additional costs beyond their agreed-upon copays, coinsurance, or deductibles. The bill establishes a minimum payment rate for out-of-network ambulance services, ensuring insurers pay 400% of the Medicare rate or the agency's billed charges, whichever is lower, and requires insurers to pay directly to the agency within 30 days of receiving a clean claim. It also mandates written notices regarding denied claims.
Key provisions
- Establishes a minimum payment rate of 400% of the CMS published rate for ground ambulance services.
- Prohibits ambulance services from billing patients or insurers for additional costs beyond agreed-upon cost-sharing amounts.
- Requires insurers to provide direct payment to non-participating ambulance services.
- Sets a 30-day deadline for insurers to remit payment for clean claims.
- Mandates written notice to patients when a claim is denied, specifying the reason for denial.
- Clarifies that copays, coinsurance, and deductibles must not exceed those charged for in-network services.
- Defines ‘full payment’ as the amount the insurer agrees to pay.
- Specifies exceptions for claim denials (e.g., another payor responsible, coordinating benefits).
Who is affected
- West Virginia residents
- Health insurance companies
- Emergency medical services agencies
- Patients receiving ambulance services
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