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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2018 Local Deductible Health Plan Insurance Program
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2018 It's Your Choice - Local Deductible Health Plan Insurance for Employees and Retirees
Wisconsin Department Of Employee Trust Funds It's Your Choice 2018

Local Deductible Plan
Insurance for Employees
and Retirees
(PO4, PO14)

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. Contact OCI at 1-800-236-8517 or your health plan if you have questions about the independent, external review law.

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: 7/25/2017 4:28:47 PM