Wisconsin Statutes Insurance (Ch. 600 to 655) § 632.855. Requirements if experimental treatment limited

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

(b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).

(a) Who is authorized to make a determination on the limitation.

(b) The criteria the plan uses to determine whether a treatment, procedure, drug or device is experimental.

(3) Denial of treatment. (am) A health care plan or a self-insured health plan that receives a request for prior authorization of an experimental procedure that includes all of the required information upon which to make a decision shall, within 5 working days after receiving the request, issue a coverage decision. If the health care plan or self-insured health plan denies coverage of an experimental treatment, procedure, drug or device for an insured who has a terminal condition or illness, the health care plan or self-insured health plan shall, as part of its coverage decision, provide the insured with a denial letter that includes all of the following:

(bm) A health care plan or a self-insured health plan may not deny coverage under par. (am) of an experimental treatment, procedure, drug, or device for an insured if the denial violates s. 632.87(6).