Relating to: transparency and regulation of prior authorization requirements under health insurance plans. (FE)

AB 432 regulates prior authorization processes for health insurance plans in Wisconsin. It requires insurance companies to follow specific transparency rules when denying coverage for medical services (called "adverse determinations"), mandating that these decisions be made by qualified health providers like physicians or nurse practitioners under medical directors' oversight. The bill defines key terms like "prior authorization" (pre-approval for services) and "urgent health care service" (requiring faster decisions), and sets deadlines for non-urgent cases. It directly affects health insurance plans, self-insured employer plans, and enrollees who seek covered services. The law aims to make the approval process clearer and more timely for patients.