Health insurance claim denials in Wisconsin
Insurers in Wisconsin denied 1,053,432 in-network claims — 13.6% of everything submitted. Just 12 reached independent external review, and 0% of those were overturned.
Wisconsin — in-network denial rate
13.6%
1,053,432 of 7,721,119 claims · 14 insurers reporting
Your rights in Wisconsin are federal. Every non-grandfathered plan must give you an internal appeal, and an independent external review for denials involving medical judgement, experimental or investigational determinations, or rescission of coverage. Your denial letter names the route and the deadline for your plan — that letter is the authority.
External review route in Wisconsin
Federal process
CMS lists Wisconsin among the states without an external review process meeting the federal standards. Insurers there must use either the HHS-administered federal process or an independent review organisation they contract with. Source: CCIIO state external review table, checked 3 August 2026.
Notice for Wisconsin, current as of 3 August 2026. CMS states that the HHS-Administered Federal External Review Process has been temporarily unavailable since 1 July 2026 for people whose plan uses that process, and that HHS will provide information about extending deadlines. This does not remove your right to external review. Follow the instructions in your own denial notice, keep dated evidence of every attempt to file, and check the CCIIO page for the current position before you rely on this. If your plan uses a contracted independent review organisation rather than the federal process, this does not affect you.
External review is not always free — but it is capped. There is no charge under the HHS-administered federal process. Where your insurer uses a contracted independent review organisation or a state process, a filing fee may apply, but it cannot exceed $25.
Insurers in Wisconsin
| Insurer | Denial rate | Denied | External reviews |
|---|---|---|---|
| Compcare Health Serv Ins Co(Anthem BCBS) | 26.9% | 68,701 | — |
| Common Ground Healthcare Cooperative | 16.5% | 465,910 | — |
| Network Health Plan | 14.5% | 35,043 | — |
| Quartz Health Benefit Plans Corporation | 13.8% | 86,327 | — |
| Molina Healthcare of Wisconsin, Inc. | 13.2% | 13,822 | — |
| Aspirus Health Plan, Inc. | 13% | 61,292 | — |
| Medica Community Health Plan | 12.3% | 54,813 | 0 |
| Dean Health Plan | 11.6% | 127,692 | — |
| MercyCare HMO, Inc. | 10.1% | 22,765 | — |
| Chorus Community Health Plans | 9.2% | 16,826 | 12 |
| Security Health Plan of Wisconsin, Inc. | 8.9% | 65,095 | — |
| Group Health Cooperative of South Central Wisconsin | 7.3% | 15,174 | — |
| HealthPartners Insurance Company | 6.4% | 19,972 | — |
| UnitedHealthcare of Wisconsin, Inc. | — | — | — |
Everything you need for your appeal in Wisconsin: your two deadlines, the argument that fits your denial reason, an evidence checklist, and the external review request. Opens on screen the moment you pay.
This page presents federal statistics and a general description of appeal rights created by federal law. It is not legal, medical, or insurance advice, and no outcome is guaranteed. Your denial letter and plan documents govern your specific case. Free help is available from your state's Consumer Assistance Program and from the federal Marketplace at HealthCare.gov.