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Code · Wisconsin · Chapter 609 — Defined network plans

609.92 Hospitals, individual practice associations and providers of physician services.

332 words·~2 min read·/wi/chapter-609/609-92-4

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609.92 Hospitals, individual practice associations and providers of physician services.
(1)Election of exemption. Except as provided in s. 609.93 , a hospital, an individual practice association or other provider described in s. 609.91
(b)may elect to be exempt from s. 609.91
(b)for the purpose of recovering health care costs arising from health care provided by the hospital, individual practice association or other provider, if the conditions under sub.
(2)or
(3), whichever is applicable, are satisfied.
(2)Care provided under a contract. If the health care is provided under a written contract between a health maintenance organization insurer and the hospital, individual practice association or other provider, all of the following conditions must be met for the hospital, individual practice association or other provider to secure an exemption under sub.
(1):
(a)The contract must be in effect on the date that the health care is provided, and the health care must be provided in accordance with the terms of the contract.
(b)The hospital, individual practice association or other provider must, within 30 days after entering into the contract, deliver to the office a written notice stating that the hospital, individual practice association or other provider elects to be exempt from s. 609.91
(b). The notice shall comply with the rules, if any, promulgated under s. 609.935 .
(3)Care provided without a contract. If the health care is not provided under a contract that satisfies sub.
(2), all of the following conditions must be met for the hospital, individual practice association or other provider to secure an exemption under sub.
(1):
(a)The hospital, individual practice association or other provider must deliver to the office a notice stating that the hospital, individual practice association or other provider elects to be exempt from s. 609.91
(b)with respect to a specified health maintenance organization insurer. The notice shall comply with the rules, if any, promulgated under s. 609.935 .
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