Wisconsin Assembly Bill AB784

Wisconsin 2023-2024 Regular Session

• Introduced: 12/8/23
• Refer: 12/8/23
• Failed: 4/15/24

Caption

Insurance coverage and balance billing for certain health care services and granting rule-making authority.

Impact

The implementation of AB784 would lead to significant changes in how emergency medical services are billed and covered by health insurance plans. By prohibiting balance billing and requiring that charges for emergency services align with in-network rates, the bill aims to relieve patients from the financial burden of unexpected surprise billing after receiving necessary medical care. Proponents argue this measure will provide peace of mind to patients when they need urgent care, knowing their financial liability will not surpass the in-network cost-sharing requirements dictated by their insurance plans.

Summary

Assembly Bill 784 seeks to address issues surrounding emergency medical services and balance billing in health insurance. The bill mandates that defined network plans, preferred provider plans, and self-insured governmental plans must cover emergency medical services regardless of whether the provider is a participating provider. This means patients will not face prior authorization requirements before receiving emergency care and cannot be billed more than in-network rates for emergency services, even from nonparticipating providers. The legislation aims to simplify access to emergency medical care and protect patients from unexpected high charge notices after their treatment.

Contention

However, some healthcare providers and insurance companies have raised concerns regarding the implications of AB784. They argue that the regulation of out-of-network billing could compromise their revenue, leading to reduced availability of certain services or emergency providers withdrawing from the network altogether. Additionally, there are fears that limiting provider billing might inadvertently discourage healthcare professionals from offering emergency services, particularly in regions where the competition for delivering such services is already fragile. These concerns underscore the ongoing debate about balancing patient protection with the economic viability of healthcare delivery.