WEST virginia Legislature

2017 regular session

Introduced

Senate Bill 276

By Senator Miller

[Introduced February 13, 2017; Referred
to the Committee on Banking and Insurance; and then to the Committee on the Judiciary]

A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §33-15-4o; to amend said code by adding thereto a new section, designated §33-16-3aa; to amend said code by adding thereto a new section, designated §33-24-7p; to amend said code by adding thereto a new section, designated §33-25-8m; and to amend said code by adding thereto a new section, designated §33-25A-8o, all relating to collection of air ambulance fees for emergency treatment or air transportation rendered to persons covered by certain insurance plans; allowing providers of air ambulance services not under contract with certain insurance plans to collect an amount up to the equivalent paid for federal reimbursement for services rendered to covered employees or dependents; and requiring providers of air ambulance services that enter into a subscription service agreement with employees or dependents covered by certain insurance plans to accept the subscription fee as payment in full for services rendered.

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 §33-15-4o; that said code be amended by adding thereto a new section, designated §33-16-3aa; that said code be amended by adding thereto a new section, designated §33-24-7p; that said code be amended by adding thereto a new section, designated §33-25-8m; and that said code be amended by adding thereto a new section, designated §33-25A-8o, all to read as follows:

ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.

§33-15-4o.  Air-ambulance fees.

(a) Notwithstanding any provision of this code to the contrary, any air-ambulance provider which does not have a contract with an insurer under this article, that provides air transportation or related emergency or treatment services to an individual who is insured by the insurer, shall bill the insurer before submitting any bill to the insured. The air-ambulance provider may not collect from the insured an amount for those services which exceeds the reimbursement amount then in effect for the federal Medicare program, including any applicable Geographic Practice Cost Index. The insurer shall apply all amounts collected by the air-ambulance provider from the insured to the insured’s deductible. The air-ambulance provider may seek to recover additional amounts from the insurer, subject to the provisions of subsection (b) of this section.

(b) If an air-ambulance provider has entered into a subscription service agreement with an individual insured by the insurer, and the individual is in good standing with the agreement, the air-ambulance provider shall accept the fee or cost of the subscription service agreement as payment in full for any air-ambulance transport and related emergency treatment or services, which the air-ambulance provider may provide to that employee or dependent of an employee.

ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.

§33-16-3aa.  Air-ambulance fees.

(a) Notwithstanding any provision of this code to the contrary, any air-ambulance provider which does not have a contract with an insurer under this article, that provides air transportation or related emergency or treatment services to an individual who is insured by the insurer, shall bill the insurer before submitting any bill to the insured. The air-ambulance provider may not collect from the insured an amount for those services which exceeds the reimbursement amount then in effect for the federal Medicare program, including any applicable Geographic Practice Cost Index. The insurer shall apply all amounts collected by the air-ambulance provider from the insured to the insured’s deductible. The air-ambulance provider may seek to recover additional amounts from the insurer, subject to the provisions of subsection (b) of this section.

(b) If an air-ambulance provider has entered into a subscription service agreement with an individual insured by the insurer, and the individual is in good standing with the agreement, the air-ambulance provider shall accept the fee or cost of the subscription service agreement as payment in full for any air-ambulance transport and related emergency treatment or services, which the air-ambulance provider may provide to that employee or dependent of an employee.

ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE CORPORATIONS, DENTAL SERVICE CORPORATIONS AND HEALTH SERVICE CORPORATIONS.

§33-24-7p.  Air-ambulance fees.

(a) Notwithstanding any provision of this code to the contrary, any air-ambulance provider which does not have a contract with an insurer under this article, that provides air transportation or related emergency or treatment services to an individual who is insured by the insurer, shall bill the insurer before submitting any bill to the insured. The air-ambulance provider may not collect from the insured an amount for those services which exceeds the reimbursement amount then in effect for the federal Medicare program, including any applicable Geographic Practice Cost Index. The insurer shall apply all amounts collected by the air-ambulance provider from the insured to the insured’s deductible. The air-ambulance provider may seek to recover additional amounts from the insurer, subject to the provisions of subsection (b) of this section.

(b) If an air-ambulance provider has entered into a subscription service agreement with an individual insured by the insurer, and the individual is in good standing with the agreement, the air-ambulance provider shall accept the fee or cost of the subscription service agreement as payment in full for any air-ambulance transport and related emergency treatment or services, which the air-ambulance provider may provide to that employee or dependent of an employee.

ARTICLE 25. HEALTH CARE CORPORATIONS.

§33-25-8m.  Air-ambulance fees.

(a) Notwithstanding any provision of this code to the contrary, any air-ambulance provider which does not have a contract with an insurer under this article, that provides air transportation or related emergency or treatment services to an individual who is insured by the insurer, shall bill the insurer before submitting any bill to the insured. The air-ambulance provider may not collect from the insured an amount for those services which exceeds the reimbursement amount then in effect for the federal Medicare program, including any applicable Geographic Practice Cost Index. The insurer shall apply all amounts collected by the air-ambulance provider from the insured to the insured’s deductible. The air-ambulance provider may seek to recover additional amounts from the insurer, subject to the provisions of subsection (b) of this section.

(b) If an air-ambulance provider has entered into a subscription service agreement with an individual insured by the insurer, and the individual is in good standing with the agreement, the air-ambulance provider shall accept the fee or cost of the subscription service agreement as payment in full for any air-ambulance transport and related emergency treatment or services, which the air-ambulance provider may provide to that employee or dependent of an employee.

ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.

§33-25A-8o.  Air-ambulance fees.

(a) Notwithstanding any provision of this code to the contrary, any air-ambulance provider which does not have a contract with an insurer under this article, that provides air transportation or related emergency or treatment services to an individual who is insured by the insurer, shall bill the insurer before submitting any bill to the insured. The air-ambulance provider may not collect from the insured an amount for those services which exceeds the reimbursement amount then in effect for the federal Medicare program, including any applicable Geographic Practice Cost Index. The insurer shall apply all amounts collected by the air-ambulance provider from the insured to the insured’s deductible. The air-ambulance provider may seek to recover additional amounts from the insurer, subject to the provisions of subsection (b) of this section.

(b) If an air-ambulance provider has entered into a subscription service agreement with an individual insured by the insurer, and the individual is in good standing with the agreement, the air-ambulance provider shall accept the fee or cost of the subscription service agreement as payment in full for any air-ambulance transport and related emergency treatment or services, which the air-ambulance provider may provide to that employee or dependent of an employee.

NOTE: The purpose of this bill is to protect West Virginia’s insured citizens from excessive charges from air-ambulance providers.

Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.