WV SB645

Out-of-network ground ambulance providers are prohibited from balance billing insured patients beyond their normal copayments, coinsurance, and deductibles for policies issued on or after January 1, 2027.

Insurers must pay out-of-network ground ambulance services at 400% of the Medicare rate for the same services in the same geographic area, or the provider's billed charges, whichever is less.

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

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

Air ambulance services are explicitly excluded from these protections; the bill applies only to ground emergency medical services.