609.30 Provider disclosures.
(1) Plan may not contract. A defined network plan may not contract with a participating provider to limit the provider's disclosure of information, to or on behalf of an enrollee, about the enrollee's medical condition or treatment options.
(2) Plan may not penalize or terminate. A participating provider may discuss, with or on behalf of an enrollee, all treatment options and any other information that the provider determines to be in the best interest of the enrollee. A defined network plan may not penalize or terminate the contract of a participating provider because the provider makes referrals to other participating providers or discusses medically necessary or appropriate care with or on behalf of an enrollee.
History: 1997 a. 237; 2001 a. 16.
Structure Wisconsin Statutes & Annotations
Wisconsin Statutes & Annotations
Chapter 609 - Defined network plans.
609.001 - Joint ventures; legislative findings.
609.03 - Indication of operations.
609.05 - Primary provider and referrals.
609.10 - Standard plan and point-of-service option plan required.
609.17 - Reports of disciplinary action.
609.20 - Rules for preferred provider and defined network plans.
609.205 - Public health emergency for COVID-19.
609.30 - Provider disclosures.
609.34 - Clinical decision-making; medical director.
609.35 - Applicability of requirements to preferred provider plans.
609.36 - Data systems and confidentiality.
609.65 - Coverage for court-ordered services for the mentally ill.
609.655 - Coverage of certain services provided to dependent students.
609.70 - Chiropractic coverage.
609.71 - Disclosure of payments.
609.715 - Coverage of alcoholism and other diseases.
609.717 - Mental health services provided by a recovery charter school.
609.75 - Adopted children coverage.
609.755 - Coverage of dependents.
609.76 - Coverage of student on medical leave.
609.77 - Coverage of breast reconstruction.
609.78 - Coverage of treatment for the correction of temporomandibular disorders.
609.79 - Coverage of hospital and ambulatory surgery center charges and anesthetics for dental care.
609.80 - Coverage of mammograms.
609.805 - Coverage of contraceptives.
609.81 - Coverage related to HIV infection.
609.82 - Coverage without prior authorization for emergency medical condition treatment.
609.83 - Coverage of drugs and devices.
609.837 - Copayment equality for oral and injected chemotherapy.
609.84 - Experimental treatment.
609.846 - Discrimination based on COVID-19 prohibited.
609.85 - Coverage of lead screening.
609.87 - Coverage of treatment for autism spectrum disorders.
609.875 - Coverage of colorectal cancer screening.
609.88 - Coverage of immunizations.
609.885 - Coverage of COVID-19 testing.
609.89 - Written reason for coverage denial.
609.90 - Restrictions related to domestic abuse.
609.91 - Restrictions on recovering health care costs.
609.92 - Hospitals, individual practice associations and providers of physician services.
609.925 - Election to be subject to restrictions.
609.93 - Scope of election by an individual practice association or clinic.
609.935 - Notices of election and termination.
609.94 - Summary of restrictions.
609.95 - Minimum covered liabilities.
609.96 - Initial capital and surplus requirements.