An Ombudsperson acts as a neutral party who helps WRS members with insurance issues.
In 2024, the Ombudsperson Services helped assist 675 cases with escalated issues, such as insurance enrollment and eligibility, denial of prior authorizations for medical services or pharmacy benefits, unpaid claims after contacting their plan, and unsubstantiated claims for the Employee Reimbursement Account program.
Oftentimes, the Ombudsperson can get involved and attempts to resolve issues prior to a WRS member being required to file a grievance with their benefits plan.
If an Ombudsperson is unable to resolve an issue, the member is notified of any appeal rights available to them.
An Ombudsperson can help determine if a WRS member is eligible for a grievance, independent external review, or ETF administrative review.
If you have an issue that you cannot directly solve with your benefits plan or need assistance, email the ETF Ombudsperson Services at ombudsperson@etf.wi.gov or call 608-261-7947.