SB 645
Prohibiting surprise billing of ground emergency medical services by nonparticipating providers
Take action
Record your position on this measure.
Sign in to record your position, submit testimony, or contact your legislator.
Sign in to take action- Introduced
- Passed Senate
- Passed House of Delegates
- To Governor
- Became Law
Bill overview
This bill prohibits ‘surprise billing’ for ground emergency medical services in West Virginia. Specifically, it ensures that health insurance companies pay ambulance services (that aren’t ‘participating’) a rate of 400% of the standard published rate or their billed charges, whichever is lower. It also prevents ambulance services from billing the insured individual for additional costs beyond copays, coinsurance, or deductibles required by the insurer. The bill includes procedures for payment, notice requirements, and exceptions for situations where the insurer hasn’t paid within 30 days.
Key provisions
- Ambulance services must be paid at 400% of the standard published rate or billed charges (whichever is lower).
- Insurers must pay non-participating ambulance services directly to the agency, not the patient.
- Copays, coinsurance, and deductibles for non-participating ambulance services cannot exceed those for participating services.
- Insurers must provide written notice if a claim is denied, explaining the reason.
- A 30-day timeframe is established for insurers to either pay or deny claims.
- The bill excludes air ambulance services.
- The bill does not apply to insurers with contracts with the Bureau for Medical Services relating to Medicaid or CHIP.
Who is affected
- Emergency Medical Services Agencies
- Health Insurance Companies
- Individuals Receiving Emergency Medical Services
- Consumers
- West Virginia Residents
Notable changes
Arguments in favor
Reasons to support this legislation.
No arguments in favor have been submitted.
Submit yoursArguments opposed
Reasons to oppose this legislation.
No arguments opposed have been submitted.
Submit yours