Section 609.05. Primary provider and referrals.

 

(1)  Except as provided in subs. (2) and (3) , a limited service health organization, preferred provider plan, or defined network plan shall permit its enrollees to choose freely among participating providers.

(2)  Subject to s. 609.22 (4) and (4m) , a limited service health organization, preferred provider plan, or defined network plan may require an enrollee to designate a primary provider and to obtain health care services from the primary provider when reasonably possible.

(3)  Except as provided in ss. 609.22 (4m) , 609.65 , and 609.655 , a limited service health organization, preferred provider plan, or defined network plan may require an enrollee to obtain a referral from the primary provider designated under sub. (2) to another participating provider prior to obtaining health care services from that participating provider.

1985 a. 29 ; 1987 a. 366 ; 1989 a. 121 ; 1997 a. 237 ; 1999 a. 9 ; 2001 a. 16 .