Senate Bill 1164 aims to prevent surprise medical bills for emergency medical services and related items under health insurance policies in Wisconsin. The bill mandates that defined network plans, preferred provider plans, and self-insured governmental plans must cover emergency medical services without requiring prior authorization, regardless of whether the provider is participating in the network. If services are provided by a nonparticipating provider, the plans cannot impose more restrictive limitations or higher cost-sharing than they would for participating providers. Additionally, the bill requires plans to calculate cost-sharing based on recognized amounts under federal law and to count any payments made by enrollees towards their in-network deductibles or out-of-pocket maximums.

For items or services provided by nonparticipating providers in participating facilities, the bill stipulates similar protections, ensuring that cost-sharing requirements are not greater than those for participating providers. Nonparticipating providers must also provide notice and obtain consent from enrollees before billing them for amounts exceeding the calculated cost-sharing amount. The bill establishes a framework for open negotiations between providers and plans regarding payment amounts and allows for an independent dispute resolution process if negotiations fail. Overall, the legislation seeks to enhance transparency and protect consumers from unexpected medical costs associated with emergency care.