Healthcare (Insurance)

failed · Wisconsin · Assembly Mar 23, 2026

AB 1189: Relating to: limitation on retroactive claim denials under health insurance policies.

This bill would limit when health insurance companies can ask people to pay back money they already received for medical claims. It directly affects individuals with disability insurance policies, health maintenance organizations, and other health coverage plans. Under the new rules, insurers can only request repayment of already paid claims within 12 months of the initial payment, or 18 months if the claim involved coordination with other programs like Medicare or state medical assistance. The only exception allows retroactive denials if the original claim information was found to be fraudulent.

Topics ✓ HealthcareSupports HealthcareBill protects patient rights by limiting retroactive claim denials, ensuring individuals maintain access to already-received healthcare benefits without unexpected repayment demands.90% confidence

Sub-Topics Insurance Medicare

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failed · Wisconsin · Senate Mar 23, 2026

SB 1136: Relating to: prior authorization for treatment of severe misalignment or malocclusion of teeth under health insurance policies and plans.

This bill prohibits disability insurance policies and self-insured health plans from using the Salzmann Evaluation Index alone to deny coverage for treating severe misalignment or malocclusion of teeth. It directly affects dental coverage under various health insurance plans, including limited service organizations, preferred provider plans, and defined network plans. The legislation requires these plans to consider additional clinical factors beyond the Salzmann Index when making prior authorization decisions for orthodontic treatment. The bill applies to policies and plans starting with the 2026-2027 plan year, with additional provisions for collective bargaining agreements.

Topics ✓ HealthcareSupports HealthcareBill prevents insurance plans from denying dental coverage based solely on one index, expanding patient access to necessary dental treatment.92% confidence

Sub-Topics Insurance

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failed · Wisconsin · Senate Mar 23, 2026

SB 1102: Relating to: reimbursement of maternal mental health screenings under the Medical Assistance program and coverage of maternal mental health screenings by health insurance policies and plans. (FE)

This bill requires health insurance policies and plans in Wisconsin to cover maternal mental health screenings for each pregnancy, while also allowing the Medical Assistance program to reimburse these screenings. The legislation mandates that screening standards be developed in consultation with organizations led by Black, Indigenous, and other persons of color, and permits licensed midwives, nurse-midwives, advanced practice registered nurses, and other qualified healthcare providers to administer the screenings. Additionally, the bill requires state disability insurance policies and self-insured health plans that include maternity coverage to include these screenings. The law takes effect on the day after publication, with specific provisions for collective bargaining agreements to apply when new or renewed.

Topics ✓ HealthcareSupports HealthcareBill mandates coverage and reimbursement for maternal mental health screenings, expanding access to mental health services and protecting patient rights.95% confidence

Sub-Topics Healthcare Workforce Insurance Mental Health

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failed · Wisconsin · Senate Mar 23, 2026

SB 1103: Relating to: special enrollment period for pregnancy.

This bill creates a special enrollment period for pregnant individuals in Wisconsin health insurance plans, allowing them to sign up for coverage at any time during their pregnancy rather than waiting for an open enrollment window. It directly affects health benefit plans, self-insured plans, and nonprofit cooperative health plans that operate under state insurance regulations. The key provision requires plans to cover pregnant individuals and their dependents starting from the first day of the month in which medical verification of pregnancy is received, with plans also required to notify enrollees about this option when first offered coverage. The bill applies to policies and plans beginning on January 1 of the year following its effective date, with special provisions for collective bargaining agreements.

Topics ✓ HealthcareSupports HealthcareBill expands health insurance access for pregnant individuals by allowing special enrollment periods, directly improving patient access to healthcare coverage.90% confidence ✓ Labor & EmploymentSupports Labor & EmploymentBill expands health insurance access for pregnant workers, strengthening worker benefits and protecting employee health coverage rights.85% confidence

Sub-Topics Insurance Collective Bargaining

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failed · Wisconsin · Senate Mar 23, 2026

SB 1147: Relating to: limitation on retroactive claim denials under health insurance policies.

This bill limits when health insurance companies can demand repayment for claims they have already paid. It applies to disability insurance policies and various health care plans, including those offered by the state, counties, and other organizations. Under the bill, insurers can only request repayment within 12 months of making the initial payment, or 18 months if the claim involved coordination with other programs like Medicare or state medical assistance. The only exception is when the original claim was based on fraudulent information. The bill would take effect for policy years beginning on the date it is enacted, with special rules for plans covered by collective bargaining agreements.

Topics ✓ HealthcareSupports HealthcareBill protects patients from retroactive claim denials, limiting insurer ability to demand repayment and strengthening consumer rights in health insurance coverage.85% confidence

Sub-Topics Insurance Medicare

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failed · Wisconsin · Assembly Mar 23, 2026

AB 1224: Relating to: establishing a publicly financed health care plan for residents of this state, creating the office of the ombudsman for patient advocacy, granting rule-making authority, and making an appropriation.

This bill proposes creating a publicly financed health care plan for Wisconsin residents and establishes a new Office of the Ombudsman for Patient Advocacy within the Department of Health Services. The ombudsman would be appointed by the health secretary to advocate for patients, and the bill creates a separate health plan fund to manage money for the program, including federal payments and donations. The legislation defines key terms like "enrollee" and "medically necessary" care, authorizes the department to seek federal waivers to implement the plan, and sets up rules for how health care providers are classified and compensated. However, the bill failed to pass in the Senate on March 23, 2026, so these changes have not been enacted.

Topics ✓ Budget & TaxesSupports Budget & TaxesBill creates a publicly financed health care plan and establishes a separate health plan fund to manage money for the program, including federal payments and donations, indicating increased funding for public services.90% confidence ✓ HealthcareSupports HealthcareBill establishes publicly financed healthcare plan, creates patient advocacy office, and allocates funding to expand access and protect patient rights.95% confidence

Sub-Topics Appropriations Insurance

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failed · Wisconsin · Assembly Mar 23, 2026

AB 1128: Relating to: insurer claims denial practices and auditing, creating the Office of the Public Intervenor, granting rule-making authority, and making an appropriation. (FE)

This bill creates a new Office of the Public Intervenor within the state insurance commissioner's office to help individuals with insurance claims, policies, and appeals for medical procedures and medications. It establishes rules requiring insurers to process disability insurance claims within reasonable timeframes, provide detailed explanations for claim denials, and disclose when artificial intelligence is used in claim decisions. The office can levy assessments on insurers based on their premium volume to fund its operations and conduct audits of claims denial practices. Additionally, the bill prohibits specific insurer practices such as using vague policy terms, stalling claim reviews, or allowing non-physician personnel to determine medical necessity.

Topics ✓ HealthcareSupports HealthcareBill creates oversight office to protect patient rights, improve insurance claim processes, and increase transparency in healthcare decisions.90% confidence ✓ TechnologySupports TechnologyBill requires insurers to disclose AI use in claim decisions, promoting transparency and consumer protection in technology applications.75% confidence

Sub-Topics Insurance Artificial Intelligence

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failed · Wisconsin · Assembly Mar 23, 2026

AB 1121: Relating to: health insurance coverage of prosthetic limbs and custom orthotic braces. (FE)

This bill requires health insurance plans, including those for government employees and public schools, to cover prosthetic limbs and custom orthotic braces when deemed medically necessary by a licensed healthcare provider. The law defines prostheses as devices that replace missing limbs and custom orthotic braces as personalized devices that correct or support musculoskeletal conditions, ensuring coverage includes materials, instruction, and repairs under specific circumstances. Coverage must match or exceed federal standards and apply to replacement or repair when medically needed due to changes in the patient's condition or when repair costs exceed 60 percent of replacement costs. The bill also mandates that plans maintain access to at least two in-network providers in the state and requires written explanations for any coverage denials based on medical necessity.

Topics ✓ HealthcareSupports HealthcareBill mandates health insurance coverage for prosthetic limbs and custom orthotic braces, expanding access to necessary medical devices and strengthening patient care.95% confidence ✓ VeteransSupports VeteransBill expands health insurance coverage for prosthetics and orthotic braces, which directly benefits veterans who often require such medical devices due to service-related injuries.75% confidence

Sub-Topics Insurance

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failed · Wisconsin · Senate Mar 30, 2026

SB 1164: Relating to: preventing surprise bills for emergency medical services and other items and services under health insurance policies and plans. (FE)

This bill aims to protect patients from unexpected medical bills by establishing rules for how health insurance plans must handle emergency care and services provided by out-of-network providers. It requires insurance plans to cover emergency medical services without prior authorization and ensures that cost-sharing amounts for out-of-network emergency care are no higher than what would apply for in-network care. Additionally, the bill mandates that plans pay out-of-network providers directly for services rendered at participating facilities and counts patient cost-sharing payments toward in-network deductibles and out-of-pocket maximums. These provisions apply to defined network plans, preferred provider plans, and self-insured governmental plans that have networks of participating providers.

Topics ✓ HealthcareSupports HealthcareBill protects patients from surprise medical bills and ensures coverage for emergency services, directly advancing patient rights and healthcare access.95% confidence

Sub-Topics Hospitals Insurance

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failed · Wisconsin · Assembly Mar 23, 2026

AB 1110: Relating to: fertility treatment rights, reimbursement of fertility treatments under the Medical Assistance program, and requiring insurance coverage for fertility treatments. (FE)

This bill establishes statutory rights for individuals, healthcare providers, insurance companies, and manufacturers to access and provide fertility treatments without interference, while also creating a legal mechanism for enforcement through private lawsuits. It defines fertility treatment broadly to include procedures like in vitro fertilization, egg and sperm preservation, genetic testing, and related medications, requiring that services follow widely accepted medical standards. The legislation mandates that health insurance issuers cover fertility treatments and allows the state to seek federal waivers to reimburse these services through the Medical Assistance program if necessary. Additionally, it grants individuals the right to make decisions about their reproductive genetic material and establishes legal protections for providers to continue treatments they have already begun.

Topics ✓ HealthcareSupports HealthcareBill expands insurance coverage for fertility treatments, protects patient access to reproductive healthcare, and establishes rights for individuals and providers to access these services without interference.95% confidence

Sub-Topics Insurance

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