Chairman Hall and Members of the House Subcommittee on Banking and Insurance , I am writing on behalf of The Health Plan, a West Virginia-based nonprofit health maintenance organization, to oppose HB 4117 - Prohibiting surprise billing of ground emergency medical services by nonparticipating providers. I’m sorry I was not able to attend the Committee Hearing on Tuesday to share my comments with you then, but I had a medical situation that kept me from the capitol. If asked, I would admittedly be one of the first to share my frustrations regarding health insurance. It can be intimidating and inarguably tedious to navigate. However, I have learned to appreciate that health insurance companies do indeed serve an important role in the healthcare delivery system, including both quality assurance and cost containment. Unfortunately, HB 4117 inhibits our ability to perform either. Cost Containment In the most basic terms, HB 4117 discourages EMS providers from joining insurance networks by rewarding them with a 400% of Medicare reimbursement rate (as a reminder, Medicare is cost-based reimbursement, so EMS is asking to receive 400% of their costs). Under normal circumstances, insurance companies and healthcare providers negotiate rates to ensure providers are reimbursed sufficiently at rates that are affordable for our members. This bill would discourage EMS agencies from network negotiations and would instead guarantee them reimbursement rates significantly higher than industry standard. State mandated reimbursement rates of this magnitude would be felt not just by health insurance companies, but also by their members, especially small businesses, in the form of rate increases. Quality Assurance Health insurers also help to protect public safety by ensuring healthcare providers are properly credentialled and following best practices. Should an EMS agency not join an insurance network, as is encouraged by this bill, our safety and oversight measures would not be in place. A patient should not have to worry about whether or not a provider has a track record of following best practices, especially when that patient is in an emergency situation. One need not look far to find similar EMS surprise billing legislation that still ensures EMS agencies are properly reimbursed but not at unmanageable rates. Our neighbors in Ohio passed a bill that would reimburse EMS at the greatest of the following:

• The median in-network rate, tied to the metropolitan statistical area, excluding any in-network cost-sharing;
• The amount that the plan would typically pay an out-of-network provider for such services, such as the usual, customary and reasonable rate, excluding any in-network cost-sharing; or
• The amount that would be paid under Medicare, excluding any in-network cost-sharing.

EMS agencies in Ohio are willing to be reimbursed at Medicare rates. Why is 400% of Medicare necessary in West Virginia? I would also like to add that the introduction of this same legislation last year has generated positive results. Before last session, insurance and EMS companies were admittedly at a standstill. EMS wouldn’t contract with insurance because of low reimbursements rates, and insurance paid low reimbursement rates because EMS providers wouldn’t sign contracts. The introduction of this legislation in 2025 did have a positive impact by helping to initiate conversations/negotiations between The Health Plan and EMS providers and I’m happy to report that we are very close to an agreement. Our first responders inarguably provide amazing public service under the most stressful of circumstances. We certainly don’t want to see any EMS agency in a situation where financial concerns inhibit their ability to assist people in need. However, we also must ensure that all providers are meeting best practices and are being reimbursed at a sustainable rate. In its current form, HB 4117 would undoubtably result in services being provided at unaffordable rates and with a lack of quality oversight. Both from a quality and financial perspective, allowing payors the opportunity to follow through with the negotiating and contracting process and arriving at an agreement with EMS providers is undoubtedly in the best interest of the patient. It is for these reasons that The Health Plan respectfully requests that you please consider opposing HB 4117, Relating to surprise billing of out-of-network ambulance services. Respectfully submitted, Megan Roskovensky Director of Government Affairs The Health Plan