Last Updated: June 21, 2019
Grievances and Complaints
Most people will never have a problem with their health insurance. But when you do have a complaint with your plan, you may be able to resolve your problem through the Wisconsin grievance process.
It is important to remember that not all health plans are subject to the Wisconsin grievance process. If your plan is self-funded by your employer, then it is subject to federal, not state law. Public programs like Medicare and Medicaid also have their own processes. Make sure you are aware of what kind of health insurance plan you have before you begin the grievance process. For further information, see the Consumer's Guide to Health Insurance Grievances and Complaints or the Fact Sheet on Filing a Complaint About Health Plans.
Health plans subject to Wisconsin's grievance process are required to submit an annual report listing the number of grievances received during the prior year. A summary of the reports is available at https://oci.wi.gov/Pages/Consumers/GrievanceReport.aspx.
Consumers are also provided an opportunity to resolve some coverage disputes through an independent review organization that has no connection to their health plan. See the
Independent Review Process for more information.
If you have questions or concerns about your insurance company or agent, write to the insurance company or agent involved. Keep a copy of the letter you write. If you do not receive satisfactory answers, you may contact the Office of the Commissioner of Insurance to file a complaint.