38.2-3407.9 - Reimbursement for ambulance services. - Virginia Statutes

§ 38.2-3407.9. Reimbursement for ambulance services.

A. If an accident and sickness insurance policy provides coverage forambulance services, any person providing such services to a person coveredunder such policy shall receive reimbursement for such services directly fromthe issuer of such policy, when the issuer of such policy is presented withan assignment of benefits by the person providing such services.

B. No (i) insurer proposing to issue individual or group accident andsickness insurance policies providing hospital, medical and surgical or majormedical coverage on an expense-incurred basis, (ii) corporation providingindividual or group accident and sickness subscription contracts, or (iii)health maintenance organization providing a health care plan for health careservices shall establish or promote an emergency medical response andtransportation system that encourages or directs access by a person coveredunder such policy, contract or plan in competition with or in substitution ofan emergency 911 system or other state, county or municipal emergency medicalsystem for ambulance services. An entity subject to this subsection may usetransportation outside an emergency 911 system or other state, county ormunicipal emergency medical system for services that are not ambulanceservices.

C. For the purposes of this section, "ambulance services" means thetransportation of any person requiring resuscitation or emergency relief orwhere human life is endangered, by means of any ambulance, rescue orlife-saving vehicle designed or used principally for such purposes. Such termincludes emergency medical services ambulances and mobile intensive careunits. No (i) insurer proposing to issue individual or group accident andsickness insurance policies providing hospital, medical and surgical or majormedical coverage on an expense-incurred basis, (ii) corporation providingindividual or group accident and sickness subscription contracts, or (iii)health maintenance organization providing a health care plan for health careservices shall require a person covered under such policy, contract or planto obtain prior authorization before accessing an emergency 911 system orother state, county or municipal emergency medical system for ambulanceservices.

(1995, c. 420; 2000, c. 630.)