By state / Wisconsin

Wisconsin

Regulator

HHS-Administered Federal External Review (MAXIMUS Federal Services) / Wisconsin OCI

External review

HHS-administered federal process (MAXIMUS Federal Services); the state does not run its own.

Published reversal rate

Not published by the regulator · source

Notes

Wisconsin operates partial state external-review framework but classified by KFF (2024) as relying on HHS-administered process for the full external-review pathway. WI OCI 2024 Wisconsin Insurance Report identified at https://oci.wi.gov/Documents/AboutOCI/2024_WIR.pdf

Before external review

File the plan's internal appeal first (at least 180 days for ACA-compliant plans; the letter states the date). Ask for the claim file and the criteria the plan applied; both are free on request. Self-funded employer plans use the federal external review and the U.S. Department of Labor, not the state.

More on Wisconsin: state appeal rights · External Review Index entry · insurer denial rates (HealthCare.gov states).

Verified 2026-09-15. The regulator's site and your denial notice control.