West Virginia legislation · 2026 Regular Session
West Virginia HB5379: To require payment by insurers directly to the out-of-network emergency medical services agency and the prompt payment of clean claims.
Status: Introduced, February 9, 2026
What the bill says
To amend the Code of West Viginia, 1931, as amended, by adding five new sections, designated §33-15-24, §33-16-20, §33-24-46, §33-25-23, and §33-25A-37, relating to requiring insurers to directly pay out-of-network emergency medical services agencies and promptly pay clean claims. ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE. §33-15-24. Requiring direct payment of nonparticipating emergency medical services agencies. (a) An insurer that receives a clean claim for covered ground ambulance services provided to a covered individual by a nonparticipating emergency medical services and (2) Ma.
From the introduced text, February 9, 2026:
A BILL to amend the Code of West Viginia, 1931, as amended, by adding five new sections, designated §33-15-24, §33-16-20, §33-24-46, §33-25-23, and §33-25A-37, relating to requiring insurers to directly pay out-of-network emergency medical services agencies and promptly pay clean claims. ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE. §33-15-24. Requiring direct payment of nonparticipating emergency medical services agencies. (a) An insurer that receives a clean claim for covered ground ambulance services provided to a covered individual by a nonparticipating emergency medical services and (2) May not send payment to the covered individual. (b) An insurer shall pay a clean claim for ground ambulance services provided to a covered individual by a nonparticipating emergency medical services agency within 30 days of receipt of the claim, except in the following (2) The insurer is coordinating benefits with another payor; (3) The provider has already been paid for the claim; (4) The claim was submitted fraudulently; or (5) There was a material misrepresentation in the claim. (c) If an insurer determines a claim for ground ambulance services provided to a covered individual by a nonparticipating emergency medical services agency is not a clean claim, the insurer shall provide written notice within 30 days and (2) States the insurer is declining to pay all or part of the claim and sets forth the specific reason …