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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2016 State of Wisconsin Group Health Insurance Program
 
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Wisconsin Department Of Employee Trust Funds

It's Your Choice 2016


State of Wisconsin
 Group Health Insurance Program
(State Employees, Retirees, Continuants and Graduate Assistants)

Independent External Review

In addition to the internal grievance process that all health plans are required to provide, federal law and Wis. Adm. Code § INS 18.11 requires all health plans to have an independent, external review procedure for review of certain decisions. These include denial of, or refusal to pay for, treatment that the insurer considers to be experimental/investigational, not medically necessary and inappropriate such as for health care setting or level of care, due to a preexisting condition exclusion denial or rescission of coverage. 

The Wisconsin Office of the Commissioner of Insurance (OCI) oversees this process, which has been in place since 2002. Contact OCI at 1-800-236-8517 or your health plan if you have questions about the independent, external review law.

Disclaimer:
Every effort has been made to ensure that this information is accurate, but may be subject to change. Please note revision dates located at the bottom of each page. In the event of conflicting information, federal law, state statute, state health contracts and/or policies and provisions established by the State of Wisconsin Group Insurance Board shall be followed.

This page was last modified on: 9/11/2015 7:53:14 PM