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Wisconsin Payment Resources
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Farm land with words Wisconsin Payment Resources

 

Summary of payment program

Wisconsin has a SAFE Fund program that reimburses healthcare providers for the cost of the medical forensic exam for victims of sexual assault. They have developed an information sheet on the SAFE Fund. The WI SAFE Fund was established by statue 949.20 the SAFE Fund Administrative Rules outline the examination services that will be covered:

  • Collection of the victim’s medical history.
  • Collection of a forensic history of the events of the assault.
  • Physical examination of the victim for evidence of the assault.
  • Photographs of the physical evidence of the sex offense, if the health care provider conducting the examination has been trained to take photographs for use as evidence.
  • Evaluation, testing, and prophylaxis for sexually transmitted diseases.
  • Evaluation of the risk of pregnancy.
  • Collection of blood and urine using the collection kit provided by law enforcement.
  • The cost for the use of its facility for the examination

 

*Victims and/or the family of the victim may NOT be billed for the examination costs that are listed above. 

Billing

The Wisconsin SAFE Fund can reimburse health care providers for the cost of a forensic medical exam for victims of sexual assault. The provider must:

  • Submit an itemized bill with the individual charges listed along with a SAFE Fund request for reimbursement form
  • Provide a bill with itemized costs with individual charges listed
  • Only one bill can be submitted for each examination
  • If the patient's insurance has paid any portion of the medical forensic exam, an EOB must be sent with the reimbursement request form and itemized bill.

Information can be mailed, faxed, or emailed as follows: 

 

Mail:

Wisconsin Department of Justice

SAFE Fund, ATTN: Courtney Watson

PO Box 7951

Madison, WI 53707-7951

 

Fax: 608-294-2928

Email: watsonca@doj.state.wi.us

 

Payment:

Wisconsin Department of Justice will:

  • Make payment directly to the healthcare provider.
  • Will pay two-thirds of the amount billed for eligible services up to a maximum amount of $1236.23 for each exam.
  • Awards in excess of the maximum amount may be awarded if the healthcare provider submits evidence that the maximum did not fairly and equitably compensate for the costs incurred in conducting the examination.
  • The maximum amount of the awards will be adjusted annually by an "inflation factor"

Wisconsin Crime Victim Compensation Application | Hmong | Spanish

 

Return completed application to:

 

Wisconsin Department of Justice

Crime Victim Compensation Program

Post Office Box 7951

Madison, WI 53707-7951

 

(608) 264-9497 or 1-800-446-6564 (Toll-free)
www.doj.state.wi.us/ocvs

 

Coordination with Healthcare

Examination Options

Examination options for patients are outlined in this form.

 

Wisconsin Coalition Against Sexual Assault - List of Sexual Assault Service Providers in Wisconsin

 

 

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