Services for Wisconsinites: Casework - Health Care
It is far past time for Congress to guarantee
health insurance coverage for all Americans. Rising health
care costs dig into families' savings accounts and businesses'
profits and prevent access to affordable health care. The
rising costs are burdening businesses and employees in Wisconsin
and across the nation, jeopardizing the ability of many Wisconsin
employers to continue coverage for their employees. And too
many patients feel trapped by the system, with decisions about
their health dictated by costs rather than by their health
care needs. I will remain vigilant in advocating for legislation
that improves access and makes health care more affordable
for the people of Wisconsin.
Frequently asked questions
What can I do if my insurance company
has denied my claims?
Health insurance companies in Wisconsin must have a formal,
internal grievance mechanism for policy holders, which is
explained in the terms of the policy. You can also file a
complaint with the Wisconsin Office of the Commissioner of
Insurance (OCI), which oversees the insurance industry in
the state. In addition, you have the right to participate
in an independent review process, in which medical professionals
who have no connection to your heath plan review your dispute.
For more information on your rights, filing a complaint, and
the complaint process, please contact OCI at 1-800-236-8517,
or visit OCI’s web address: http://oci.wi.gov/
My employer says my policy is
self-insured. Is it still regulated by the state?
If your employer-sponsored insurance plan is self-insured,
it may be regulated by the U.S. Department of Labor rather
than the OCI. For more information, you may call the Chicago
regional office of the Department of Labor, Employee Benefits
Security Administration, at (312)-353-0900.
I am a federal employee
enrolled in the Federal Employees Health Benefits program.
Who do I contact with problems about a claim?
The Office of Personnel Management (OPM) administers the Federal
Employees Health Benefits program and resolves disputed health
insurance claim disputes between the enrollee and the carrier.
If you have questions regarding your claim or the dispute
process, call 1-888-767-6738.
How can I file a complaint
if I believe that an insurance company is defrauding me or
violating the terms of my policy?
The Wisconsin Office of the Commissioner of Insurance (OCI)
enforces state law governing insurance companies and agents,
and can assist individuals with a variety of insurance problems.
For more information on filing a complaint and the complaint
process, please visit OCI’s web address: http://oci.wi.gov/
I do not have insurance. Are there
any state programs that can help me?
The Wisconsin Department of Health and Family Services (DHFS)
- http://www.dhfs.state.wi.us
- offers plans for individuals who are uninsured. BadgerCare
is a program that provides coverage for uninsured families.
In order to qualify, you must have children under age 19 living
with you, your income must be within the guideline limits
(there is no limit on assets), and you must not be covered
by health insurance. For more information on BadgerCare, you
can call 1-800-362-3002.
The Wisconsin Health Insurance Risk Sharing Plan (HIRSP) offers
health insurance to Wisconsin residents who are unable to
find health insurance coverage in the private market due to
their medical conditions or who have lost their employer-sponsored
group health insurance. To find out if you qualify, you can
call 1-800-828-4777.
Are there any federal resources
for uninsured individuals?
There are a number of federally funded clinics around the
state that provide services. Please visit the Health Resources
and Services Administration web address, http://ask.hrsa.gov/pc/,
in order to determine the clinics nearest to your location.
You can also contact HRSA at 1-888-ASK-HRSA (1-888-275-4772)
for information on publications, resources, and referrals
on health care services for low-income, uninsured individuals
and those with special health care needs.
Is it possible to obtain a drug
or medical device while it is under review with the FDA?
The FDA recognizes that there are circumstances in which an
investigational product is the only option available for a
patient faced with a serious, albeit not life-threatening,
condition (This is referred to as "compassionate use").
If the drug or medical device qualifies for the compassionate
use program, the only way to obtain it is through the manufacturer.
It is common for physicians or physician’s medical researchers
to contact manufacturers on behalf of their patients if the
case qualifies for a compassionate use program.
How do I file a petition or comment
with the FDA?
As a regulatory agency, the FDA publishes rules that establish
or modify the way it regulates foods, drugs, biologics, cosmetics,
radiation-emitting electronic products, and medical devices.
Anyone can participate in the rule-making process by commenting
in writing on rules the FDA proposes. Questions about the
comment, petition or hearing process should go to the FDA
Dockets Management Branch at (301) 827-6860.
Petitions should be mailed or delivered to the Dockets Management
Branch, Food and Drug Administration, Room 1061, 5630 Fishers
Lane, Rockville, MD 20852. You can also visit the FDA’s
web address on this process: http://www.fda.gov/opacom/backgrounders/voice.html
How do I report a problem with
a product that is regulated by the FDA?
For more information about how to report a problem to the
FDA, please visit: http://www.fda.gov/opacom/backgrounders/problem.html
Is there a number I can call if
I have a general question for the FDA?
If you have a general question about an FDA-regulated product,
call 1-888-INFO-FDA (1-888-463-6332).
How do I find out if a drug or
medical device has recently been approved by the FDA?
For more information on recently approved prescription drugs,
visit the web address for the Center for Drug Evaluation and
Research (CDER).
http://www.fda.gov/cder/drug/default.htm#New%20Prescription%20Drug%20Approvals
For more information on recently approved medical devices,
visit the web address for the Center for Devices and Radiological
Health (CDRH).
http://www.fda.gov/cdrh/consumer/mda/index.html
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