WI SB711

Defined network plans, preferred provider plans, and self-insured governmental plans must cover out-of-network emergency ambulance services at either a mutually agreed rate, a rate set by local government, or 350% of Medicare rates (whichever is less than the billed amount).

Insurers cannot impose higher cost-sharing on enrollees for out-of-network emergency ambulance services than would apply for in-network providers, and ambulance providers cannot balance bill patients beyond standard copays, coinsurance, and deductibles.

Health insurers and self-insured plans must pay clean claims for emergency ambulance services within 30 days directly to the ambulance provider, or notify providers of claim defects within 30 days.

Interfacility ambulance transports (between facilities when services are unavailable at the originating location) must be reimbursed as medically necessary emergency services when accompanied by a proper medical necessity certification.

Air ambulance services are excluded from the bill's requirements; the law takes effect on the first day of the 4th month after publication and applies to new policy years.