632.798 Out-of-pocket costs.
(1) Definitions. In this section:
(a) “Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
(b) “Health care provider" has the meaning given in s. 146.903 (1) (c) and includes a hospital, as defined in s. 50.33 (2).
(c) “Insured" includes an enrollee under a self-insured health plan and a representative or designee of an insured or enrollee.
(d) “Self-insured health plan" means a self-insured health plan of the state or a county, city, village, town, or school district.
(2) Provide estimate.
(a) A self-insured health plan or an insurer that provides coverage under a disability insurance policy shall, at the request of an insured, provide to the insured a good faith estimate, as of the date of the request and assuming no medical complications or modifications in the insured's treatment plan, of the insured's total out-of-pocket cost according to the insured's benefit terms for a specified health care service in the geographic region in which the health care service will be provided.
(b) An estimate provided by an insurer or self-insured health plan under this section is not a legally binding estimate of the out-of-pocket cost.
(c) An insurer or self-insured health plan may not charge an insured for providing the information under this section.
(d) Before providing the information requested under par. (a), the insurer or self-insured health plan may require the insured to provide in writing any of the following information:
1. The name of the health care provider providing the service.
2. The facility at which the service will be provided.
3. The date the service will be provided.
4. The health care provider's estimate of the charge for the service.
5. The codes for the service under the Current Procedural Terminology of the American Medical Association or under the Current Dental Terminology of the American Dental Association.
(e) The requirement to provide the information requested under par. (a) does not apply if the health care provider providing the health care service is any of the following:
1. A health care provider that practices individually or in association with not more than 2 other individual health care providers.
2. A health care provider that is an association of 3 or fewer individual health care providers.
History: 2009 a. 146.
Copyright ©2024 LegalFix. All rights reserved. LegalFix is not a law firm, is not licensed to practice law, and does not provide legal advice, services, or representation. The information on this website is an overview of the legal plans you can purchase—or that may be provided by your employer as an employee benefit or by your credit union or other membership group as a membership benefit.
LegalFix provides its members with easy access to affordable legal services through a network of independent law firms. LegalFix, its corporate entity, and its officers, directors, employees, agents, and contractors do not provide legal advice, services, or representation—directly or indirectly.
The articles and information on the site are not legal advice and should not be relied upon—they are for information purposes only. You should become a LegalFix member to get legal services from one of our network law firms.
You should not disclose confidential or potentially incriminating information to LegalFix—you should only communicate such information to your network law firm.
The benefits and legal services described in the LegalFix legal plans are not always available in all states or with all plans. See the legal plan Benefit Overview and the more comprehensive legal plan contract during checkout for coverage details in your state.
Use of this website, the purchase of legal plans, and access to the LegalFix networks of law firms are subject to the LegalFix Terms of Service and Privacy Policy.