H. B. 4462
(By Delegates Marshall, Perdue and Long)
[Introduced February 9, 2006; referred to the
Committee on Banking and Insurance then the Judiciary.]
A BILL to amend the Code of West Virginia, 1931, as amended, by
adding thereto a new section, designated §33-16-16a, relating
to assigning benefits directly to providers based on the
patients assignment of benefit form.
Be it enacted by the Legislature of West Virginia:
That the Code of West Virginia, 1931, as amended, be amended
by adding thereto a new section, designated §33-16-16a, to read as
follows:
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-16a. Assignment of health insurance benefits.
(a) Any carrier that provides health coverage to a covered
person shall allow, but not require, such covered person under the
policy to assign, in writing, payments due under the policy to a
licensed hospital, or other licensed health care provider, for
services provided to the covered person that are covered under the policy.
(b) The covered person may, with or without the agreement of
the provider, revoke the assignment. Such revocation shall be in
writing and shall be sent to the carrier. The carrier shall send
a copy of the revocation to the provider who is the subject of the
revocation. The revocation shall be effective when it has been
received by both carrier and the provider and shall only affect
those charges incurred after such receipt by both.
(c) When a provider receives an assignment from a covered
person, it is the responsibility of the provider to bill the
carrier and notify the carrier that the provider holds an
assignment on file. The carrier shall honor the assignment the
same as if a copy of the assignment had been received by the
carrier. Only upon request of the carrier shall the provider be
required to give the carrier a copy of the assignment.
(d) The carrier shall honor the assignment and make payment of
covered benefits directly to the provider. If the carrier fails to
honor the assignment by making payment to the covered person and if
the covered person, upon receipt of such payment, fails to pay an
amount equivalent to such payment to the provider within forty-five
days, the carrier shall be liable for the payment directly to the
provider. It shall be the responsibility of the provider to notify
the carrier if payment has not been received. In such case, the
carrier shall make payment of covered benefits as specified in article sixteen of this chapter.
(e) If the provider collects payment from the enrollee and
subsequently received payment from the carrier, the provider shall
reimburse the enrollee, less any applicable copayments,
deductibles, or coinsurance amounts, within forty-five days.
(f) Nothing in this section shall be construed to limit a
carrier's ability to determine the scope of its benefits, services,
or any other terms of its policies, or from negotiating contracts
with licensed hospitals or other licensed health care providers on
reimbursement rates or any other lawful provisions.
NOTE: The purpose of the bill is to allow covered persons to
assign their benefits to providers and establishes criteria.
§33-16-16a is new; therefore, strike-throughs and underscoring
have been omitted.