Independent Review Organizations Certified to
Perform Independent Reviews in Wisconsin
Wisconsin's independent review process may help you resolve some disputes with your health plan regarding its coverage denial. This process allows you to have a medical expert with no connection to your health plan review the health plan's decision. An independent review is available whenever your health plan denies you coverage because it maintains that the treatment is not medically necessary or appropriate or that the treatment is experimental or investigational. You may also request an independent review if your health plan denies coverage based on a preexisting condition exclusion or if it rescinds your health insurance policy or certificate.
Both state and federal law give individuals the right to request an independent external review of some of their health plan's decisions. If your health plan is required to follow the federal law, it is not limited to using the Wisconsin-certified IROs listed below.
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 p d f format for printing at: http://oci.wi.gov/iroscert.pdf (opens in new window). 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:
| Name | Address | Phone/Fax/Web Address | Contact |
|---|---|---|---|
| IPRO | 1979 Marcus Ave. Lake Success, NY 11042-1002 |
800-227-3143 516-304-3760 (fax) www.ipro.org |
Terese Giorgio ext. 223 |
| MAXIMUS - Center for Health Dispute Resolution | Eastgate Square 50 Square Dr. Ste. 210 Victor, NY 14564-1099 |
866-763-6395 585-425-5296 (fax) www.healthappeal.com |
Lisa Maguire, Esq. or Dolores Christensen Cover page should specify: Not a Medicare Appeal |
| MCMC LLC | 300 Crown Colony Dr. Ste. 203 Quincy, MA 02169 |
888-313-6267 301-652-1250 (fax) www.mcmcllc.com |
Amy Taylor or Amber Tharp 301-652-1818 |
| Medical Consultants Network, Inc. | 901 Boren Ave. Ste. 1400 Seattle, WA 98104 |
800-636-3926 206-623-4956 (fax) www.mcn.com |
Erik Halse ext. 2206 |
| Medical Review Institute of America | 2875 S. Decker Lake Dr. Ste. 550 PO Box 25547 Salt Lake City, UT 84125-0547 |
800-654-2422 801-261-3189 (fax) www.mrioa.com |
Aja Ogzewalla ext. 6475 |
| National Medical Reviews, Inc. | 8 Neshaminy Interplex Ste 207 Trevose, PA 19053 |
800-283-8196 215-352-7801 (fax) www.nmrusa.com |
Elaine Nace, Esq. ext. 106 |
| Permedion | 350 Worthington Rd. Ste. H Westerville, OH 43082-8325 |
800-473-0802 614-895-6784 (fax) www.permedion.com |
Sue Butterfield ext. 3428 |
| Prest & Associates | 2712 Marshall Court Ste. 1 Madison, WI 53705 |
800-358-5129 608-232-9929 (fax) www.prestmds.com |
Susan Prest |
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