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Introduced Version House Bill 2123 History

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Key: Green = existing Code. Red = new code to be enacted
H. B. 2123


(By Delegate Marshall)
[Introduced February 11, 2009; referred to the
Committee on Banking and Insurance then the Judiciary.]




A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §33-16-16a, relating to assigning benefits directly to providers based on the patient's assignment of benefit form.

Be it enacted by the Legislature of West Virginia:
That the Code of West Virginia, 1931, as amended, be amended by adding thereto a new section, designated §33-16-16a, to read as follows:
ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.

§33-16-16a. Assignment of health insurance benefits.
(a) Any carrier that provides health coverage to a covered person shall allow, but not require, such covered person under the policy to assign, in writing, payments due under the policy to a licensed hospital, or other licensed health care provider, for services provided to the covered person that are covered under the policy.
(b) The covered person may, with or without the agreement of the provider, revoke the assignment. Such revocation shall be in writing and shall be sent to the carrier. The carrier shall send a copy of the revocation to the provider who is the subject of the revocation. The revocation is effective when it has been received by both carrier and the provider and only affects those charges incurred after such receipt by both.
(c) When a provider receives an assignment from a covered person, it is the responsibility of the provider to bill the carrier and notify the carrier that the provider holds an assignment on file. The carrier shall honor the assignment the same as if a copy of the assignment had been received by the carrier. Only upon request of the carrier shall the provider be required to give the carrier a copy of the assignment.
(d) The carrier shall honor the assignment and make payment of covered benefits directly to the provider. If the carrier fails to honor the assignment by making payment to the covered person and if the covered person, upon receipt of such payment, fails to pay an amount equivalent to such payment to the provider within forty-five days, the carrier shall be liable for the payment directly to the provider. It is the responsibility of the provider to notify the carrier if payment has not been received. In such case, the carrier shall make payment of covered benefits as specified in article sixteen of this chapter.
(e) If the provider collects payment from the enrollee and subsequently received payment from the carrier, the provider reimburses the enrollee, less any applicable copayments, deductibles, or coinsurance amounts, within forty-five days.
(f) Nothing in this section shall be construed to limit a carrier's ability to determine the scope of its benefits, services, or any other terms of its policies, or from negotiating contracts with licensed hospitals or other licensed health care providers on reimbursement rates or any other lawful provisions.




NOTE: The purpose of this bill is to assign benefits directly to providers based on the patient's assignment of benefit form.

Strike-throughs indicate language that would be stricken from the present law, and underscoring indicates new language that would be added.
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