Senate Bill 711 aims to enhance the coverage and reimbursement processes for emergency ambulance services under health insurance policies and plans in Wisconsin. The bill mandates that defined network plans, preferred provider plans, and self-insured governmental plans must cover emergency ambulance services provided by non-participating ambulance service providers at specified rates. These rates are prioritized as follows: a mutually agreed rate between the plan and the provider, a rate set or approved by a local governmental entity, or a rate that is 350% of the Medicare published rate for the services, whichever is lower. Additionally, the bill prohibits plans from imposing higher cost-sharing amounts on enrollees than would apply if the services were provided by a participating provider.

Furthermore, the bill establishes requirements for timely claims processing, stipulating that health insurance policies or self-insured plans must respond to claims for emergency ambulance services within 30 days. They are required to remit payment directly to the ambulance service provider for medically necessary services, provided that a medical necessity certification is included with the claim. The bill also introduces new sections to the statutes, specifically 609.825 and 632.851, which detail the coverage and reimbursement processes for emergency ambulance services, ensuring that enrollees are not charged additional amounts beyond their cost-sharing responsibilities.

Statutes affected:
Bill Text: 40.51(8), 40.51, 40.51(8m), 66.0137(4), 66.0137, 120.13(2)(g), 120.13, 185.983(1)(intro.), 185.983