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Bill > SB711

WI SB711

WI SB711
Coverage and reimbursement of emergency ambulance services under health insurance policies and plans. (FE)

summary

Introduced
12/02/2025
In Committee
12/02/2025
Crossed Over
Passed
Dead

Introduced Session

2025-2026 Regular Session

Bill Summary

This bill makes several changes to the coverage and reimbursement of emergency ambulance services under health insurance policies and plans. Under the bill, defined network plans, preferred provider plans, and self- insured governmental plans that provide coverage of emergency medical services are required to cover emergency ambulance services provided by an ambulance service provider that is not a participating provider at one of the following rates, according to this order of priority: 1. A rate that is mutually agreed upon by the plan and the ambulance service provider. 2. A rate that is set or approved by a local governmental entity in the jurisdiction in which the emergency ambulance services originated. 3. A rate that is 350 percent of the Medicare program’s published rate for the services in the same geographic area or a rate that is equivalent to the rate billed by the ambulance service provider for the services, whichever is less. LRB-5395/1 EKL:cdc 2025 - 2026 Legislature SENATE BILL 711 The bill provides that an ambulance service provider that is reimbursed at the applicable rate may not charge an enrollee an additional amount for the emergency ambulance services except for any cost-sharing responsibility, such as a copayment, coinsurance, or deductible. The bill also prohibits the plan from imposing a cost- sharing amount on an enrollee that is greater than the amount that would have applied had the ambulance service provider been a participating provider. The bill further requires that a health insurance policy or self-insured governmental health plan respond to claims for covered emergency ambulance services within 30 days by remitting payment directly to the ambulance service provider or by notifying the provider of any defect with the claim. The bill also provides that the policy or plan must remit payment for the transportation of a patient by ambulance (including transport from one facility to another to receive services not available at the first) as a medically necessary emergency ambulance service at a rate as described above if the ambulance service provider includes with its claim for payment a medical necessity certification statement signed by an individual who meets criteria established by federal regulations. For further information see the state fiscal estimate, which will be printed as an appendix to this bill. This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats.

AI Summary

This bill addresses emergency ambulance services coverage and reimbursement in health insurance policies and plans, establishing a comprehensive framework to protect patients from unexpected financial burdens. The bill requires defined network plans, preferred provider plans, and self-insured governmental plans to cover emergency ambulance services from non-participating providers at a prioritized rate structure: first, at a mutually agreed rate; second, at a rate set by local government; and third, at 350 percent of Medicare's published rate or the provider's billed rate, whichever is less. Importantly, the bill prohibits ambulance providers from charging patients additional amounts beyond standard cost-sharing responsibilities and prevents insurance plans from imposing higher cost-sharing for out-of-network emergency ambulance services compared to in-network services. The legislation also mandates that insurance policies must respond to emergency ambulance service claims within 30 days, either by directly paying the ambulance provider or by notifying the provider of any claim defects. Additionally, the bill requires plans to reimburse ambulance transportation as a medically necessary service if the provider includes a medical necessity certification statement from a qualified individual. These provisions aim to create more transparent and fair billing practices for emergency medical transportation, reducing potential financial strain on patients during medical emergencies.

Committee Categories

Agriculture and Natural Resources

Sponsors (21)

Last Action

Senator Marklein added as a coauthor (on 01/30/2026)
(1 Companion Bills)

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