WV HB4117

Out-of-network ground ambulance providers are prohibited from balance billing insured patients beyond their normal copayment, coinsurance, and deductible amounts, effective January 1, 2027 for most policy types.

Insurers must pay non-participating EMS agencies at 400% of the Medicare rate for the same service in the same geographic area, or the provider's billed charges, whichever is lower.

Patient cost-sharing for out-of-network ground ambulance services cannot exceed what would be charged for in-network ambulance services.

Insurers must pay or deny clean claims within 30 days and remit payment directly to the EMS agency rather than to the patient.

Air ambulance services are explicitly excluded from these surprise billing protections.