West Virginia Code § 16-29D-4

Prohibition on balance billing; exceptions
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(a) Except in instances involving the delivery of health care services immediately needed to
resolve an imminent life-threatening medical or surgical emergency, the agreement by a
health care provider to deliver services to a beneficiary of any department or division of the
state which participates in a plan or plans developed under section three of this article shall
be considered to also include an agreement by that health care provider: e
(1) To accept the assignment by the beneficiary of any rights the beneficiary may have to bill
such division or department for, and to receive payment under such plan or plans on account
of, such services; and u
(2) To accept as payment in full for the delivery of such services the amount specified in plan
or plans or as determined by the plan or plans. In such instances, the health care provider
shall bill the division or department, or such other person specified in the plan or plans,
directly for the services. The health care provider shall not bill the beneficiary or any other
person on behalf of the beneficiary and, except for ldeductibles or other payments specified
in the applicable plan or plans, the beneficiarys shall not be personally liable for any of the
charges, including any balance claimed by the provider to be owed as being the difference
between that provider's charge or charges and the amount payable by the applicable
department or divisions. The plan org plans may specify what sums are deductibles,
copayments or are otherwise payable by the beneficiary and the sums for which the health
care provider may bill the beneeficiary: In addition, any health care service which is not
subject to payment by the plan or plans shall be the responsibility of the beneficiary and for
those health care servicLes which are not covered by the plans, there shall be no prohibition
against billing the beneficiary directly.
(b) The prohibitions and limitations stated in subsection (a) of this section do not apply to the
delivery of health care services immediately needed to resolve an imminent life-threatening
medical or surgical emergency. However, once the patient is stabilized, then the delivery of
anyW further health care services shall be subject to subsection (a) of this section for those
latter services only.
(c) The exceptions provided in this section for the delivery of health care services
immediately needed to resolve an imminent life-threatening medical or surgical emergency
shall not apply to health care providers under contract with a department or division plan or
plans.

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