Wisconsin: Start Here
Beginner guide for Wisconsin—HealthCare.gov, OCI independent review, § 632.83 grievance & § 632.835 IRO.
Read guideState playbook
Wisconsin
State insurers, legislation, and appeal resources for patients and advocates in Wisconsin.
4 guides
Wisconsin Prior Authorization Law
§ 632.85 emergency PA ban, § 632.855 experimental 5-day rule; federal CMS 7-day / 72-hour timing.
Read guideWisconsin Health Insurance Appeals and Grievances
§ 632.83 grievance panel, 180-day filing, path to OCI-certified IRO you select.
Read guideWisconsin Independent Review (OCI / IRO)
Binding on insurer—4 months to file, 30 business-day standard / 72-hour expedited.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- Anthem Blue Cross Blue Shield Wisconsin
- UnitedHealthcare of Wisconsin
- Quartz Health Plan
- Dean Health Plan / SSM Health Plan
- Network Health
- Security Health Plan
- CareSource (Common Ground Healthcare Cooperative)
- HealthCare.gov (Wisconsin)
- BadgerCare Plus / ForwardHealth MCOs
External appeals
After internal appeal, for eligible Wisconsin fully insured plans only.
- OCI — independent review
- Medicaid — fair hearing