Assembly Bill 720 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 capped at 350% of the Medicare published rate for the services in the same geographic area. Additionally, the bill prohibits ambulance service providers from charging enrollees more than their cost-sharing responsibilities and requires health plans to respond to claims within 30 days.

The bill also introduces new sections to the statutes, specifically 609.825 and 632.851, which outline the requirements for coverage and reimbursement of emergency ambulance services. Under these sections, health plans must remit payment directly to ambulance service providers for clean claims and cannot send payments to enrollees. Furthermore, the legislation stipulates that ambulance service providers cannot bill enrollees for additional amounts beyond their cost-sharing responsibilities. The bill is set to take effect four months after publication, with specific applicability provisions for policies affected by collective bargaining agreements.

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