West Virginia legislature proposes bill to prevent surprise ambulance billing

In a pivotal meeting of the Senate Health and Human Resources Committee on March 27, 2025, lawmakers discussed a proposed bill aimed at reforming how emergency medical services (EMS) are compensated for ground ambulance services. The bill seeks to protect patients from surprise billing when they receive care from out-of-network EMS agencies, a situation that has left many individuals facing unexpected costs despite having insurance coverage.

Under the proposed legislation, insurers would be required to pay non-participating EMS agencies directly, ensuring that patients are not billed for any amount beyond their cost-sharing obligations. This means that if a patient uses an out-of-network ambulance service, they would only be responsible for the same cost-sharing amount they would have incurred had they used an in-network service. The bill stipulates that payments to EMS agencies would be capped at either 400% of the Medicare rate for similar services in the area or the agency's billed charges, whichever is lower.

The discussion highlighted the urgency of addressing the financial strain on EMS agencies, many of which have struggled to stay afloat amid rising operational costs and inadequate reimbursement rates from insurers. Dr. Mike Thomas, the chief government affairs officer at Jancare Ambulance, emphasized that the bill would help ensure that EMS agencies are compensated fairly, allowing them to avoid balance billing patients for the difference between what insurers pay and the actual cost of services rendered.

Senators raised questions about the rationale behind the 400% figure, with some expressing a desire for further clarification on its selection. Dr. Thomas noted that similar legislation has been enacted in 13 other states, indicating a growing recognition of the need for reform in this area.

The bill does not apply to Medicaid or CHIP services, and it is expected to have no cost to the state. As the committee moves forward, the proposed legislation will require further review and a fiscal note before it can be enacted, with an effective date set for January 1, 2026.

As West Virginia grapples with the challenges facing its EMS system, this bill represents a significant step toward ensuring that patients receive necessary emergency care without the burden of unexpected financial consequences. The committee's discussions reflect a broader commitment to safeguarding public health and supporting the vital services that EMS agencies provide to communities across the state.