Small picture of Wisconsin capital.State of Wisconsin, Office of the Commissioner of Insurance
Abbreviation for Office of the Commissioner of Insurance, O C I.
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   Independent Review Annual Reports

Independent Review Requests
for Calendar Year 2008

According to State insurance law, health insurance claimants have a right to an independent review of an adverse decision by an insurer of their claims. These reviews are carried out by Independent Review Organizations (IROs) registered with the Office of the Commissioner of Insurance (OCI). Every year, IROs certified to do reviews in Wisconsin are required to submit to the OCI a report for the prior calendar year's experience. The independent review process allows a consumer to appeal some health insurance claims denials to an independent third party. The results from the reports for calendar year 2008 are summarized below.

A total of 110 review requests were submitted to the 6 certified IROs for consideration. In 10 cases, the IRO declined the request. A review request may be declined for a number of reasons. If the request does not involve a question of whether the treatment is medically necessary or whether it is experimental, it is not eligible for an independent review. An IRO may also decline a review if it determines that it may have a potential conflict of interest or if it receives a request directly from a consumer rather than from the insurer.

The time needed to make a decision varies depending on the complexity of the case. On average an IRO took 22 days from the date it received the review request to make a decision. An IRO will review a case on an expedited basis when a delay in obtaining treatment could jeopardize the health or life of the consumer. During 2008, three cases were reviewed on an expedited basis and the IRO made its decision within 3 days.

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.

Independent Review Organizations Certified to Perform Independent Reviews in Wisconsin

Name of
Insurance Company		Total Review Requests ReceivedIndependent Review OrganizationsNumber of Decisions
that IRO:
IPROMaximus
-CHDR		MCMCMedical
Review
Inst. of
America		PermedionPrestUpheldReversed
Aetna Life Ins. Co.*600040231
AIG Life Ins. Co.100001010
American Republic Ins. Co.100001010
Blue Cross Blue Shield of Wisconsin*520002131
Compcare Health Services Ins. Corp.410201022
Dean Health Plan, Inc.#812113044
Group Health Coop of South Central WI110000010
Gundersen Lutheran Health Plan, Inc.300021030
Health Tradition Health Plan100010010
HIRSP401111031
Humana Ins. Co.411002022
Humana Wis. Health Organization Ins. Corp.431000013
Medica Ins. Co.100100010
MercyCare HMO*210000101
Midwest Security Life Ins. Co.300012030
Network Health Plan#710231061
Physicians Plus Insurance Corp.*100001000
Principal Life ins. Co.400220022
Security Health Plan of Wisconsin, Inc.110000001
Time Ins. Co.*321000011
Trustmark Life Ins. Co.110000001
United HealthCare Ins. Co*851002042
UnitedHealthcare of Wisconsin, Inc.*950012144
Unity Health Plans Insurance Corp421010031
WEA Insurance Corp.#401012031
Wisconsin Auto & Truck Dealers Insurance Corp.210010020
Wisconsin Physicians Service Ins. Corp.*#1662224087
WPS Health Plan, Inc.#210001020
Totals110351111212756436
*Total review requests received does not equal total number of decisions because Independent Review Organization declined one or more cases.
#Permedion included a review request received in December 2007 in its 2008 report.

Updated: May 28, 2009
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