West Virginia Code § 33-25A-7a

Provider contracts
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(1) Whenever a contract exists between a health maintenance organization and a provider
and the organization fails to meet its obligations to pay fees for services already rendered to
a subscriber, the health maintenance organization is liable for the fee or fees rather than the
subscriber; and the contract shall state that liability.
(2) No subscriber of a health maintenance organization is liable to any provider of health
care services for any services covered by the health maintenance organization if at any time
during the provision of the services, the provider, or its agents, are aware the subscriber is a
health maintenance organization enrollee. u
(3) If at any time during the provision of the services, a provider, or its agents, are aware
that the subscriber is a health maintenance organization enrollee, that provider of services
or any representative of the provider may not collect or attempt to collect from a health
maintenance organization subscriber any money for services covered by a health
maintenance organization and no provider or reprelsentative of the provider may maintain
any action at law against a subscriber of a heaslth maintenance organization to collect money
owed to the provider by a health maintenance organization.
(4) Every contract between a healthg maintenance organization and a provider of health care
services shall be in writing and shall contain a provision that the subscriber is not liable to
the provider for any services covered by the subscriber's contract with the health
maintenance organization.
(5) The provisions of this section shall not be construed to apply to the amount of any
deductible or copayment which is not covered by the contract of the health maintenance
organization.
(6) When a subscriber receives covered emergency health care services from a
noncontracting provider, the health maintenance organization shall be responsible for
payment of the providers normal charges for those health care services, exclusive of any
applicable deductibles or copayments.
(7) For all provider contracts executed on or after April 15, one thousand nine hundred
ninety-five, and within one hundred eighty days of that date for contracts in existence on
that date:
(a) The contracts must provide that the provider shall provide sixty days advance written
notice to the health maintenance organization and the commissioner before canceling the
contract with the health maintenance organization for any reason; and
(b) The contract must also provide that nonpayment for goods or services rendered by the
provider to the health maintenance organization is not a valid reason for avoiding the sixty
day advance notice of cancellation.
(8) Upon receipt by the health maintenance organization of a sixty day cancellation notice,
the health maintenance organization may, if requested by the provider, terminate the
contract in less than sixty days if the health maintenance organization is not financially
impaired or insolvent.

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