Section 632.85. Coverage without prior authorization for treatment of an emergency medical condition.

 

(1)  In this section:

(a) “Emergency medical condition" means a medical condition that manifests itself by acute symptoms of sufficient severity, including severe pain, to lead a prudent layperson who possesses an average knowledge of health and medicine to reasonably conclude that a lack of immediate medical attention will likely result in any of the following:

1. Serious jeopardy to the person's health or, with respect to a pregnant woman, serious jeopardy to the health of the woman or her unborn child.

2. Serious impairment to the person's bodily functions.

3. Serious dysfunction of one or more of the person's body organs or parts.

(b) “Health care plan" has the meaning given in s. 628.36 (2) (a) 1.

(c) “Self-insured health plan" means a self-insured health plan of the state or a county, city, village, town or school district.

(2)  If a health care plan or a self-insured health plan provides coverage of any emergency medical services, the health care plan or self-insured health plan shall provide coverage of emergency medical services that are provided in a hospital emergency facility and that are needed to evaluate or stabilize, as defined in section 1867 of the federal Social Security Act, an emergency medical condition.

(3)  A health care plan or a self-insured health plan that is required to provide the coverage under sub. (2) may not require prior authorization for the provision or coverage of the emergency medical services specified in sub. (2) .

1997 a. 155 .