WI · guidance
Wis. ForwardHealth Online Handbook, Hospice, Topic #227
Conditions That Must Be Met
A member may request a noncovered service, a covered service for which PA (prior authorization) was denied (or modified), or
a service that is not covered under the member's limited benefit category. The charge for the service may be collected from the
member if the following conditions are met prior to the delivery of that service:
• The member accepts responsibility for payment.
• The provider and member make payment arrangements for the service.
Providers are strongly encouraged to obtain a written statement in advance documenting that the member has accepted
responsibility for the payment of the service.
Furthermore, the service must be separate or distinct from a related, covered service. For example, a vision provider may provide
a member with eyeglasses but then, upon the member's request, provide and charge the member for anti-glare coating, which is a
noncovered service. Charging the member is permissible in this situation because the anti-glare coating is a separate service and
can be added to the lenses at a later time.
Provenance
- Source
- www.forwardhealth.wi.gov
- Retrieved
- 2026-10-02
- Edition
- forwardhealth-hospice-2026-10-01
- Content hash
051c04a6c4800744a443e440a9c08bf7f643c79914fa97bedd85f5b28c15c4fb
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