HB 4117
Prohibiting surprise billing of ground emergency medical services by nonparticipating providers
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- Passed House of Delegates
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill prohibits ambulance services providers from ‘surprise billing’ West Virginia residents for emergency medical services. Specifically, it requires health insurance companies to pay nonparticipating ambulance services agencies at least 400% of the Medicare rate or their billed charges, whichever is lower, for ground ambulance services provided to covered individuals. The bill also limits the amount individuals are required to pay in copays, coinsurance, and deductibles, and mandates that insurers pay these agencies within 30 days of receiving a clean claim, providing written notice if payment is delayed.
Key provisions
- Requires insurers to pay nonparticipating ambulance services agencies at least 400% of the Medicare rate or billed charges for ground ambulance services.
- Limits cost-sharing amounts (copays, coinsurance, deductibles) that individuals must pay for ambulance services.
- Prohibits ambulance services agencies from billing individuals for additional costs beyond cost-sharing amounts.
- Establishes a 30-day timeframe for insurers to remit payment for clean claims.
- Requires insurers to provide written notice if payment is not made within 30 days.
- Specifies exceptions to the 30-day payment timeframe.
- Defines ‘full payment’ to an ambulance service.
- Requires insurers to provide specific reasons for denied claims.
Who is affected
- West Virginia residents
- Health insurance companies
- Nonparticipating ambulance services agencies
- Emergency medical services providers
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