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 in the following order: 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 ambulance service providers from charging enrollees any amount beyond their cost-sharing responsibilities, such as copayments or deductibles, and limits the cost-sharing amounts to those applicable if the services were provided by a participating provider.

The bill also introduces new requirements for health insurance policies and self-insured plans regarding the timely processing of claims for emergency ambulance services. Specifically, these plans must remit payment for clean claims within 30 days directly to the ambulance service provider and must notify the provider of any issues with non-clean claims within the same timeframe. Furthermore, the bill establishes that reimbursement for medically necessary emergency ambulance services must be made at the rates outlined in the new section 609.825, which includes provisions for transport between facilities. The bill includes amendments to existing statutes to incorporate these changes and creates new sections 609.825 and 632.851 to formalize the coverage and reimbursement processes for emergency ambulance services.

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