SB 717
Prohibiting surprise billing of ground emergency medical services by nonparticipating providers
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Sign in to take action- Introduced
- Passed Senate
- Passed House of Delegates
- To Governor
- Became Law
Bill overview
This bill prohibits hospitals and ambulance services from charging insured individuals more than they would pay with in-network coverage for ground emergency medical services. It requires insurers to pay nonparticipating ambulance services the greater of 400% of the Medicare rate or the agency’s billed charges, and ensures direct payment from the insurer to the agency within 30 days of a clean claim. The bill also mandates written notices to patients when claims are denied and limits cost-sharing amounts to those paid by in-network providers.
Key provisions
- Requires insurers to pay nonparticipating ambulance services at least 400% of the Medicare rate or the agency's billed charges, whichever is lower.
- Prohibits ambulance services from billing insured individuals for additional costs beyond copays, coinsurance, and deductibles.
- Mandates direct payment from insurers to nonparticipating ambulance services within 30 days of a clean claim.
- Limits cost-sharing amounts for ground ambulance services to those paid by in-network providers.
- Requires insurers to provide written notice to patients when claims are denied, specifying the reason for denial.
- Defines ‘full payment’ as the amount the insured would pay with a participating provider.
- Specifies exceptions to the 30-day payment timeframe.
- Clarifies that air ambulance services are excluded from the scope of this bill.
Who is affected
- Health insurance policyholders
- Emergency medical services agencies (both participating and nonparticipating)
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