Last Updated: February 17, 2015
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. You can also contact OCI at the address on the How to Contact Us page to request a copy.
The following organizations, listed in alphabetical order, have been certified as IROs in Wisconsin:
Advanced Medical Reviews||10780 Santa Monica Blvd., Ste 333|
Los Angeles, CA 90025-4779
|AMR Account Services Dept.|
IPRO||1979 Marcus Ave.|
Lake Success, NY 11042-1002
MAXIMUS - Center for|
Health Dispute Resolution
3750 Monroe Ave., Ste. 705
Pittsford, NY 14534-1302
|Lisa Maguire, Esq.|
Cover page should specify:
Not a Medicare Appeal
|MCMC LLC||1451 Rockville Pike, Ste. 440|
Rockville, MD 20852
|Medical Consultants Network, LLC||1301 5th Ave., Ste. 2900|
Seattle, WA 98101
|Medical Review Institute of America||2875 S. Decker Lake Dr., Ste. 300|
PO Box 25547
Salt Lake City, UT 84125-0547
National Medical Reviews, Inc.||260 Knowles Ave., Ste. 330|
Southampton, PA 18966
|Elaine Nace, Esq.|
Prest & Associates||401 Charmany Dr., Ste. 305|
Madison, WI 53719
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.
Further questions may be directred to: