It's Your Choice 2017
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 adverse benefit determinations. These include, but are not limited to, denial of, or refusal to pay for, treatment that the insurer considers to be experimental/investigational, not medically necessary, inappropriate such as for health care setting, level of care, effectiveness of a covered benefit, or due to a 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.
This page was last modified on: 8/16/2016 1:09:29 PM