West VirginiaLaw caps ground ambulance bills for policies issued starting in 2027
For policies issued on or after January 1, 2027, the law caps patients’ covered ground ambulance bills, with an exception for health maintenance organization insurers holding Medicaid or CHIP contracts.
What it does
For policies issued on or after January 1, 2027, patients owe no more than their plan’s in-network share for covered ground ambulance services. The health maintenance organization section excludes insurers with Medicaid or CHIP contracts.
For policies issued on or after January 1, 2027, insurers pay covered ground ambulance agencies directly, at no more than twice Medicare’s rate. The health maintenance organization section excludes insurers with Medicaid or CHIP contracts.
For policies issued on or after January 1, 2027, insurers generally have 30 days to pay or deny certain ambulance claims and must explain denials in writing. The health maintenance organization section excludes insurers with Medicaid or CHIP contracts.
Argument forPatients covered by these rules could avoid extra ambulance bills because agencies must accept insurer payments and patients’ capped shares as full payment.
Argument againstAmbulance agencies could receive less than their billed charges when those charges exceed twice Medicare’s rate for the same service and area.
More detail
Ambulance agencies must accept the required insurer payment and the patient’s required share as full payment. These rules cover insured ground ambulance services from agencies outside the insurer’s network. Air ambulances are excluded. Patients still owe deductibles, copays, and other required shares, capped at what their plan requires for an agency in its network. The health maintenance organization section excludes insurers with Medicaid or CHIP contracts with West Virginia’s Bureau for Medical Services. The law took effect June 11, 2026. These billing rules apply to health insurance policies issued on or after January 1, 2027.
Insurers must pay ambulance agencies directly at the lower of the agency’s bill or twice the current Medicare rate. The formula covers insured ground ambulance services from agencies outside the insurer’s network. Air ambulances are excluded. The Medicare comparison uses the same ambulance service in the same geographic area. The health maintenance organization section excludes insurers with Medicaid or CHIP contracts with West Virginia’s Bureau for Medical Services. The payment formula applies to health insurance policies issued on or after January 1, 2027.
Insurers must pay or deny clean claims within 30 days, with exceptions, and explain claim denials in writing. These duties cover claims for insured ground ambulance services from agencies outside the insurer’s network. The pay-or-deny deadline has exceptions for another payer’s responsibility, coordination with another payer, prior payment, fraud, or a significant false statement. Denial notices must give the claim’s receipt date and explain the denial or identify the additional information needed. The health maintenance organization section excludes insurers with Medicaid or CHIP contracts with West Virginia’s Bureau for Medical Services. The 30-day deadline runs from receipt of a clean claim. The law also requires direct payment to the ambulance agency within 30 days of receiving a clean claim.
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Where it stands
- Introduced
- Passed Senate
- Passed House
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Jun 25Chapter 57, Acts, Regular Session, 2026Latest
- Apr 1Approved by Governor Patrick Morrisey 4/1/2026Major
- Mar 18To Governor 3/18/2026To Governor
- Mar 14Approved by Governor Patrick Morrisey 4/1/2026 - House JournalMajor
- Mar 14Approved by Governor Patrick Morrisey 4/1/2026 - Senate JournalBecame Law
- Mar 14To Governor 3/18/2026 - Senate JournalMinor
- Mar 13Completed legislative action
- Vote recorded Senate concurred in House amendments and passed bill. Result: pass.Upper
- Mar 13Communicated to House
- Mar 13Senate concurred in House amendments and passed bill (Roll No. 601)
- Mar 13House Message received
- Mar 12Communicated to Senate
- Vote recorded TABLE RECONSIDER H HHR AM #1. Result: fail.Lower
- Vote recorded PREVIOUS QUESTION. Result: pass.Lower
- Vote recorded RECONSIDER H HHR AM #1. Result: pass.Lower
- Vote recorded PASSAGE. Result: pass.Lower
- Mar 12Title amendment adopted (Voice vote)
- Mar 12Passed House (Roll No. 435)Passed House
- Mar 12Read 3rd timeMinor
- Mar 12Amendment rejected (Voice vote)Minor
- Mar 12Amendment reported by the Clerk
- Mar 12Amendment adopted (Voice vote)
- Mar 12Amendment reported by the Clerk
- Mar 12Amended on 3rd reading
- Mar 12Amendment adopted (Voice vote)
- Mar 12Amendment adopted (Voice vote)
- Mar 12Amendment reported by the Clerk
- Mar 12Motion to reconsider amendment (Roll No. 434)
- Mar 12Motion for previous question adopted (Roll No. 433)
- Mar 12Motion to table motion to reconsider amendment rejected (Roll No. 432)Minor
- Mar 12Motion to reconsider
- Mar 12Reported by the Clerk
- Mar 12On 3rd reading, Special Calendar
- Mar 11Committee amendment rejected (Voice vote)Minor
- Mar 11Amendment reported by the Clerk
- Mar 11Read 2nd timeMinor
- Mar 11On 2nd reading, Special Calendar
- Mar 10Read 1st timeMinor
- Mar 10Immediate consideration
- Mar 10With amendment, do passMinor
- Feb 25Markup Discussion
- Feb 12To House Health and Human ResourcesMinor
- Feb 12To Health and Human ResourcesMinor
- Feb 12Introduced in HouseMinor
- Feb 12House received Senate message
- Feb 11Ordered to House
- Vote recorded Passage. Result: pass.Upper
- Feb 11Passed Senate (Roll No. 67)Passed Senate
- Feb 11Read 3rd timeMinor
- Feb 11On 3rd reading
- Feb 10Read 2nd timeMinor
- Feb 10On 2nd reading
- Feb 9Read 1st timeMinor
- Feb 9On 1st reading
- Feb 6Reported do passMinor
- Jan 28To Health and Human ResourcesMinor
- Jan 28Introduced in SenateMinor
- Jan 28To Health and Human ResourcesMinor
- Jan 28Filed for introductionIntroduced
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