West Virginia 2026 Session Status: Enacted 1 R cosponsors

SB 645 — Prohibiting surprise billing of ground emergency medical services by nonparticipating providers

Last action — Chapter 57, Acts, Regular Session, 2026

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  1. ✓
    Introduced
  2. ✓
    In Committee
  3. ✓
    Passed Senate
  4. ✓
    Passed House of Delegates
  5. ✓
    To Executive
  6. 6
    Enacted

This bill has been enacted into law. Introduced January 28, 2026. Enacted.

Prognosis

Likely to advance 72% · moderate confidence

Where this bill stands today.

Odds of enactment

High

How often bills like it became law.

  • Enacted

    Current position in the legislative process.

  • 1 sponsor

    1 primary, 0 co-sponsors signed on.

  • Single-party support

    Sponsorship is currently within one party (1 R).

  • Cleared a recorded vote

    Passed 3 recorded votes so far.

Prognosis reads this bill's own signals — stage, sponsorship breadth, committee status, recorded votes and cross-state momentum. Odds come from a model trained on which bills have become law.

In plain language

The bill prohibits surprise billing for ground emergency medical services by nonparticipating providers.

This legislation aims to stop surprise billing practices for emergency medical services provided by out-of-network providers. It addresses the issue of unexpected charges that patients may face when receiving emergency care.

What this means for you
  • Consumers: This means you may no longer face unexpected bills from out-of-network ambulance services in emergencies.

Summary

Prohibiting surprise billing of ground emergency medical services by nonparticipating providers

Bill Text

What changed in the latest version

293 added · 1 removed

Plain-language change summary

The updated version of Senate Bill 645 introduces specific protections for patients receiving ground emergency medical services from out-of-network providers. It prohibits surprise billing, meaning that if a patient uses a non-participating ambulance service, their insurance will be required to cover the cost fully (minus any standard co-pays and deductibles). This change matters because it helps ensure that patients are not hit with unexpected charges during emergencies, making healthcare more predictable and affordable for them.

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SB645 HFAT Worrell 3-12 #1CR 3338 Delegate Worrell moved to amend the bill by striking out the title and substituting therefor a new title, to read as follows:“A Bill to amend the Code of West Virginia, 1931, as amended, by adding new sections, designated §33-15-24, §33-16-20, §33-24-46, §33-25-23, and §33-25A-37, relating to out-of-network ambulance services;
WEST VIRGINIA LEGISLATURE REGULAR SESSION Enrolled Senate Bill 645 BYSENATORDEEDS [Passed March 13, 2026;
in effect 90 days from passage (June 11, 2026)] Enr SB 645 AN ACT to amend the Code of West Virginia, 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 out- of-network ambulance services;
and requiring written notices for denied claims.”   AdoptedRejected 
and requiring written notices for denied claims.
Be it enacted by the Legislature of West Virginia:
ARTICLE 15.
ACCIDENT AND SICKNESS INSURANCE.
§33-15-24.
Prohibiting surprise billing of ground emergency medical services by nonparticipating providers.
For a health insurance policy issued by an insurer on or after January 1, 2027:
(1) Payment by an insurer to a non-participating emergency medical services agency for covered ambulance services provided under the provisions of §16-4C-1 et seq.
of this code, excluding air ambulance services as defined in §16-4C-3(a) of this code, to a covered enrollee in accordance with subdivision (2) of this section:
(A) Shall be considered payment in full for the ambulance services provided, except for any copayment, coinsurance, deductible, and other cost-sharing amounts that the insurer requires the covered enrollee to pay;
and (B) The non-participating emergency medical services agency is prohibited from billing the covered individual for any additional amount for the ambulance services provided, except for any copayment, coinsurance, deductible, and other cost-sharing amounts that the insurer requires the covered enrollee to pay.
(2) The insurer shall provide direct payment to a non-participating emergency medical services agency for covered ground ambulance services provided to a covered individual:
(A) At the rate of 200 percent of the current published rate for ambulance services as established by the Centers for Medicare and Medicaid Services under Title XVIII of the federal Social Security Act, 42 U.S.C.
1395 et seq., for the same ambulance services provided in the same geographic area;
or Enr SB 645 E(B) According to the non-participating emergency medical services agency's billed charges, whichever is less.
(3) The copayment, coinsurance, deductible, and other cost-sharing amounts that an insurer requires a covered individual to pay in connection with ground ambulance services provided to the covered individual by a non-participating emergency medical services agency shall not exceed the copayment, coinsurance, deductible, and other cost-sharing amounts that the covered individual would be required to pay if the ambulance services had been provided to the covered individual by a participating emergency medical services agency.
(4) If an insurer receives a clean claim for ground ambulance services provided to a covered individual by a non-participating emergency medical services agency, the insurer shall remit payment for the ambulance services directly to the non-participating emergency medical services agency not more than 30 days after receiving a clean claim and shall not send payment to the covered individual.
(5) An insurer shall either pay or deny a clean claim for ground ambulance services provided to a covered individual by a non-participating emergency medical services agency within 30 days of receipt of the claim, except in the following circumstances:
(A) Another payor or party is responsible for the claim;
(B) The insurer is coordinating benefits with another payor;
(C) The provider has already been paid for the claim;
(D) The claim was submitted fraudulently;
or (E) There was a material misrepresentation in the claim.
(6) If an insurer denies a claim for ground ambulance services provided to a covered individual by a non-participating emergency medical services agency, the insurer shall provide written notice that:
(A) Acknowledges the date of the receipt of the claim;
and Enr SB 645 (B) States that the insurer is declining to pay all or part of the claim and sets forth the specific reason or reasons for declining to pay the claim in full;
or (C) States that additional information is needed to determine whether all or part of the claim is payable and specifically describes the additional information that is needed.
ARTICLE 16.
GROUP ACCIDENT AND SICKNESS INSURANCE.
§33-16-20.
Prohibiting surprise billing of ground emergency medical services by non- participating providers.
For a health insurance policy issued by an insurer on or after January 1, 2027:
(1) Payment by an insurer to a non-participating emergency medical services agency for covered ambulance services provided under the provisions of §16-4C-1 et seq.
of this code, excluding air ambulance services as defined in §16-4C-3(a) of this code, to a covered enrollee in accordance with subdivision (2) of this section:
Shall be considered payment in full for the ambulance services provided, except for any copayment, coinsurance, deductible, and other cost-sharing amounts that the insurer requires the covered enrollee to pay.
(2) The insurer shall provide direct payment to a non-participating emergency medical services agency for covered ground ambulance services provided to a covered individual:
(A) At the rate of 200 percent of the current published rate for ambulance services as established by the Centers for Medicare and Medicaid Services under Title XVIII of the federal Social Security Act, 42 U.S.C.
1395 et seq., for the same ambulance services provided in the same geographic area;
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or (B) According to the non-participating emergency medical service agency's billed charges, whichever is less.
(3) The copayment, coinsurance, deductible, and other cost-sharing amounts that an insurer requires a covered individual to pay in connection with ground ambulance services provided to the covered individual by a non-participating emergency medical services agency Enr SB 645 shall not exceed the copayment, coinsurance, deductible, and other cost-sharing amounts that the covered individual would be required to pay if the ambulance services had been provided to the covered individual by a participating emergency medical services agency.
(4) If an insurer receives a clean claim for ground ambulance services provided to a covered individual by a non-participating emergency medical services agency, the insurer shall remit payment for the ambulance services directly to the non-participating emergency medical services agency not more than 30 days after receiving a clean claim and shall not send payment to the covered individual.
(5) An insurer shall either pay or deny a clean claim for ground ambulance services provided to a covered individual by a non-participating emergency medical services agency within 30 days of receipt of the claim, except in the following circumstances:
(A) Another payor or party is responsible for the claim;
(B) The insurer is coordinating benefits with another payor;
(C) The provider has already been paid for the claim;
(D) The claim was submitted fraudulently;
or (E) There was a material misrepresentation in the claim.
(6) If an insurer denies a claim for ground ambulance services provided to a covered individual by a non-participating emergency medical services agency, the insurer shall provide written notice that:
(A) Acknowledges the date of the receipt of the claim;
and (B) States that the insurer is declining to pay all or part of the claim and sets forth the specific reason or reasons for declining to pay the claim in full;
or (C) States that additional information is needed to determine whether all or part of the claim is payable and specifically describes the additional information that is needed.
Enr SB 645 ARTICLE 24.
HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE CORPORATIONS, DENTAL SERVICE CORPORATIONS, AND HEALTH SERVICE CORPORATIONS.
§33-24-46.
Prohibiting surprise billing of ground emergency medical services by non- participating providers.
For a health insurance policy issued by an insurer on or after January 1, 2027:
(1) Payment by an insurer to a non-participating emergency medical services agency for covered ambulance services provided under the provisions of §16-4C-1 et seq.
of this code, excluding air ambulance services as defined in §16-4C-3(a) of this code, to a covered enrollee in accordance with subdivision (2) of this section:
Shall be considered payment in full for the ambulance services provided, except for any copayment, coinsurance, deductible, and other cost-sharing amounts that the insurer requires the covered enrollee to pay.
(2) The insurer shall provide direct payment to a non-participating emergency medical services agency for covered ground ambulance services provided to a covered individual:
(A) At the rate of 200 percent of the current published rate for ambulance services as established by the Centers for Medicare and Medicaid Services under Title XVIII of the federal Social Security Act, 42 U.S.C.
1395 et seq., for the same ambulance services provided in the same geographic area;
or (B) According to the non-participating emergency medical service agency's billed charges, whichever is less.
(3) The copayment, coinsurance, deductible, and other cost-sharing amounts that an insurer requires a covered individual to pay in connection with ground ambulance services provided to the covered individual by a non-participating emergency medical services agency shall not exceed the copayment, coinsurance, deductible, and other cost-sharing amounts that Enr SB 645 the covered individual would be required to pay if the ambulance services had been provided to the covered individual by a participating emergency medical services agency.
(4) If an insurer receives a clean claim for ground ambulance services provided to a covered individual by a non-participating emergency medical services agency, the insurer shall remit payment for the ambulance services directly to the non-participating emergency medical services agency not more than 30 days after receiving a clean claim and shall not send payment to the covered individual.
(5) An insurer shall either pay or deny a clean claim for ground ambulance services provided to a covered individual by a non-participating emergency medical services agency within 30 days of receipt of the claim, except in the following circumstances:
(A) Another payor or party is responsible for the claim;
(B) The insurer is coordinating benefits with another payor;
(C) The provider has already been paid for the claim;
(D) The claim was submitted fraudulently;
or (E) There was a material misrepresentation in the claim.
(6) If an insurer denies a claim for ground ambulance services provided to a covered individual by a non-participating emergency medical services agency, the insurer shall provide written notice that:
(A) Acknowledges the date of the receipt of the claim;
and (B) States that the insurer is declining to pay all or part of the claim and sets forth the specific reason or reasons for declining to pay the claim in full;
or (C) States that additional information is needed to determine whether all or part of the claim is payable and specifically describes the additional information that is needed.
ARTICLE 25.
HEALTH CARE CORPORATIONS.
§33-25-23.
Prohibiting surprise billing of ground emergency medical services by non- participating providers.
Enr SB 645 For a health insurance policy issued by an insurer on or after January 1, 2027:
(1) Payment by an insurer to a non-participating emergency medical services agency for covered ambulance services provided under the provisions of §16-4C-1 et seq.
of this code, excluding air ambulance services as defined in §16-4C-3(a) of this code, to a covered enrollee in accordance with subdivision (2) of this section:
Shall be considered payment in full for the ambulance services provided, except for any copayment, coinsurance, deductible, and other cost-sharing amounts that the insurer requires the covered enrollee to pay.
(2) The insurer shall provide direct payment to a non-participating emergency medical services agency for covered ground ambulance services provided to a covered individual:
(A) At the rate of 200 percent of the current published rate for ambulance services as established by the Centers for Medicare and Medicaid Services under Title XVIII of the federal Social Security Act, 42 U.S.C.
1395 et seq., for the same ambulance services provided in the same geographic area;
or (B) According to the non-participating emergency medical service agency's billed charges, whichever is less.
(3) The copayment, coinsurance, deductible, and other cost-sharing amounts that an insurer requires a covered individual to pay in connection with ground ambulance services provided to the covered individual by a nonparticipating emergency medical services agency shall not exceed the copayment, coinsurance, deductible, and other cost-sharing amounts that the covered individual would be required to pay if the ambulance services had been provided to the covered individual by a participating emergency medical services agency.
(4) If an insurer receives a clean claim for ground ambulance services provided to a covered individual by a non-participating emergency medical services agency, the insurer shall remit payment for the ambulance services directly to the nonparticipating emergency medical Enr SB 645 services agency not more than 30 days after receiving a clean claim and shall not send payment to the covered individual.
(5) An insurer shall either pay or deny a clean claim for ground ambulance services provided to a covered individual by a non-participating emergency medical services agency within 30 days of receipt of the claim, except in the following circumstances:
(A) Another payor or party is responsible for the claim;
(B) The insurer is coordinating benefits with another payor;
(C) The provider has already been paid for the claim;
(D) The claim was submitted fraudulently;
or (E) There was a material misrepresentation in the claim.
(6) If an insurer denies a claim for ground ambulance services provided to a covered individual by a nonparticipating emergency medical services agency, the insurer shall provide written notice that:
(A) Acknowledges the date of the receipt of the claim;
and (B) States that the insurer is declining to pay all or part of the claim and sets forth the specific reason or reasons for declining to pay the claim in full;
or (C) States that additional information is needed to determine whether all or part of the claim is payable and specifically describes the additional information that is needed.
ARTICLE 25A.
HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-37.
Prohibiting surprise billing of ground emergency medical services by non- participating providers.
(a) For a health insurance policy issued by an insurer on or after January 1, 2027:
(1) Payment by an insurer to a non-participating emergency medical services agency for covered ambulance services provided under the provisions of §16-4C-1 et seq.
of this code, excluding air ambulance services as defined in §16-4C-3(a) of this code, to a covered enrollee in accordance with subdivision (2) of this subsection:
Enr SB 645 (A) Shall be considered payment in full for the ambulance services provided, except for any copayment, coinsurance, deductible, and other cost-sharing amounts that the insurer requires the covered enrollee to pay;
and (B) The non-participating emergency medical services agency is prohibited from billing the covered individual for any additional amount for the ambulance services provided, except for any copayment, coinsurance, deductible, and other cost-sharing amounts that the insurer requires the covered enrollee to pay.
(2) The insurer shall provide direct payment to a non-participating emergency medical services agency for covered ground ambulance services provided to a covered individual:
(A) At the rate of 200 percent of the current published rate for ambulance services as established by the Centers for Medicare and Medicaid Services under Title XVIII of the federal Social Security Act, 42 U.S.C.
1395 et seq., for the same ambulance services provided in the same geographic area;
or (B) According to the non-participating emergency medical service agency's billed charges;
whichever is less.
(3) The copayment, coinsurance, deductible, and other cost-sharing amounts that an insurer requires a covered individual to pay in connection with ground ambulance services provided to the covered individual by a non-participating emergency medical services agency shall not exceed the copayment, coinsurance, deductible, and other cost-sharing amounts that the covered individual would be required to pay if the ambulance services had been provided to the covered individual by a participating emergency medical services agency.
(4) If an insurer receives a clean claim for ground ambulance services provided to a covered individual by a non-participating emergency medical services agency, the insurer shall remit payment for the ambulance services directly to the non-participating emergency medical services agency not more than 30 days after receiving a clean claim and shall not send payment to the covered individual.
Enr SB 645 (5) An insurer shall either pay or deny a clean claim for ground ambulance services provided to a covered individual by a non-participating emergency medical services agency within 30 days of receipt of the claim, except in the following circumstances:
(A) Another payor or party is responsible for the claim;
(B) The insurer is coordinating benefits with another payor;
(C) The provider has already been paid for the claim;
(D) The claim was submitted fraudulently;
or (E) There was a material misrepresentation in the claim.
(6) If an insurer denies a claim for ground ambulance services provided to a covered individual by a non-participating emergency medical services agency, the insurer shall provide written notice that:
(A) Acknowledges the date of the receipt of the claim;
and (B) States that the insurer is declining to pay all or part of the claim and sets forth the specific reason or reasons for declining to pay the claim in full;
or (C) States that additional information is needed to determine whether all or part of the claim is payable and specifically describes the additional information that is needed.
(b) This section shall not apply to insurers that have a contract with the Bureau for Medical Services relating to Medicaid or CHIP.
Enr SB 645 The Clerk of the Senate and the Clerk of the House of Delegates hereby certify that the foregoing bill is correctly enrolled.
...............................................................
Clerk of the Senate ...............................................................
Clerk of the House of Delegates Originated in the Senate.
In effect 90 days from passage.
...............................................................
President of the Senate ...............................................................
Speaker of the House of Delegates __________ The within is ................................................
this the...........................................
Day of ..........................................................................................................., 2026.
.............................................................
Governor 11
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Action History

  1. Filed for introduction

  2. To Health and Human Resources

  3. Introduced in Senate

  4. To Health and Human Resources

  5. Reported do pass

  6. On 1st reading

  7. Read 1st time

  8. On 2nd reading

  9. Read 2nd time

  10. On 3rd reading

  11. Read 3rd time

  12. Passed Senate (Roll No. 67)

  13. Ordered to House

  14. House received Senate message

  15. Introduced in House

  16. To Health and Human Resources

  17. To House Health and Human Resources

  18. Markup Discussion

  19. With amendment, do pass

  20. Immediate consideration

  21. Read 1st time

  22. On 2nd reading, Special Calendar

  23. Read 2nd time

  24. Amendment reported by the Clerk

  25. Committee amendment rejected (Voice vote)

  26. On 3rd reading, Special Calendar

  27. Reported by the Clerk

  28. Motion to reconsider

  29. Motion to table motion to reconsider amendment rejected (Roll No. 432)

  30. Motion for previous question adopted (Roll No. 433)

  31. Motion to reconsider amendment (Roll No. 434)

  32. Amendment reported by the Clerk

  33. Amendment adopted (Voice vote)

  34. Amendment adopted (Voice vote)

  35. Amended on 3rd reading

  36. Amendment reported by the Clerk

  37. Amendment adopted (Voice vote)

  38. Amendment reported by the Clerk

  39. Amendment rejected (Voice vote)

  40. Read 3rd time

  41. Passed House (Roll No. 435)

  42. Title amendment adopted (Voice vote)

  43. Communicated to Senate

  44. House Message received

  45. Senate concurred in House amendments and passed bill (Roll No. 601)

  46. Communicated to House

  47. Completed legislative action

  48. To Governor 3/18/2026

  49. To Governor 3/18/2026 - Senate Journal

  50. Approved by Governor 4/1/2026

  51. Approved by Governor 4/1/2026 - Senate Journal

  52. Approved by Governor 4/1/2026 - House Journal

  53. Chapter 57, Acts, Regular Session, 2026

Sponsors

Sponsorship breakdown

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1 sponsors · 0 co-sponsors · 151 not signed on

Sponsors (1)

Co-sponsors (0)

None.

Not signed on (151)

151 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

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Frequently asked questions

What does SB 645 do?
Prohibiting surprise billing of ground emergency medical services by nonparticipating providers
Who sponsors SB 645?
SB 645 is sponsored by Vince Deeds (Republican).
What is the current status of SB 645?
This bill has been enacted into law. Introduced January 28, 2026. Enacted.
Where can I track SB 645?
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