If your health plan denies coverage of a service based on a medical necessity or experimental treatment determination, Wisconsin's independent review process may help you resolve your dispute. This process allows you to have a medical expert with no connection to your health plan review the health plan's decision. In most cases, you will first be required to complete your health plan's internal grievance process. If your health plan's internal grievance process results in an adverse determination, you may choose an Independent Review Organization (IRO) from the list below and send your request for an independent review to your health plan.

The Fact Sheet on the Independent Review Process in Wisconsin provides more information about this process. It can be found at http://oci.wi.gov/pub_list/pi-203.htm. You can also contact OCI at the address on the How to Contact Us page to request a copy.

A copy of the listing of organizations certified is available in pdf format for printing at: http://oci.wi.gov/iroscert.pdf. Note: You will need an Adobe Acrobat Reader to view or print pdf version, which you can download at no cost from Adobe .

The following organizations, listed in alphabetical order, have been certified as IROs in Wisconsin:

Your health plan should provide you with information on your right to request an independent review in its written materials. You can also call the health plan at its toll-free number and request information on independent review.

Independent Review Annual Reports
Independent Review Process Minimum Adjusted Dollar Amount

Further questions may be directed to: ocihmo@wisconsin.gov