Wisconsin’s governor wants to audit denied health claims by insurance companies

Wisconsin’s governor Tony Evers wants to hold insurance companies accountable and push for initiatives to improve the health care of its citizens. As part of Governor Evers’ state budget plan, he intends on auditing insurance companies when they repeatedly deny claims made by his constituents.

Evers’ 2025–2027 Executive Budget includes sweeping changes in how Wisconsinites access health care. Along with auditing health insurers who frequently deny claims, Evers is pushing to reduce appointment waiting times at medical facilities, eliminate sales tax for over-the-counter medications, prevent surprise medical billing and report unpaid medical debt to collection and credit bureaus, extend postpartum coverage for new mothers and their babies, mental health initiatives, and invest money into hospitals throughout the state to improve health care (especially in rural areas). Those aren’t the only proposals.

“As part of my comprehensive plan to lower costs for working families, I’m also proposing sweeping plans to lower costs for prescriptions and medication and crack down on price gouging and health insurers,” said Evers. “Let’s finally make lowering everyday, out-of-pocket costs for medication a bipartisan priority this session.”

This movement by the governor would make Wisconsin the first state in America to have an office to enact a correction action plan that enforces insurers to provide coverage if constituents are unjustifiably declined. This comes at a time when, according to a 2023 Kaiser Family Foundation poll, 58% of insured American adults experienced a problem with their health insurance. Along with that, four in ten Americans who had trouble paying medical debt cited health insurance denials as part of their problem. A Commonwealth Fund survey also found that 47% of those who dealt with a denied claim reported that their health issue worsened because of it. That survey also found that 45% of participants were charged for a service they thought was free or covered by their insurance plan.

Nearly half of insured people were billed for a service they thought was covered.Photo credit: Canva

“Folks can’t get a straight answer on what’s covered by insurance and what’s not,” says Evers. “People get sicker and health problems get worse because it takes too long to get an appointment or be approved for care—if it’s ever approved at all. People try to get their care paid for but insurance companies refuse to cover it. Families get a medical bill and see all sorts of charges they didn’t know about. Or, even worse, suddenly, collections agencies are calling about unpaid medical bills they didn’t even know they hadn’t paid.”

If you wish to see improvement in health care access in your state, the American Medical Association has some suggested starting points: Investigate the medical facilities in your area to see if they offer telehealth services, if they could improve efficiency when seeing and processing patients, and if they have a shortage of physicians. Ask them what needs to be done to address those issues. You can bring this up to town hall meetings, write to your representatives, and join with others who see this as an issue worth addressing. You can research or even help draft proposals to bring about change in your state’s health care or back up candidates that champion your views.

There are ways you can help improve health care services in your state.Photo credit: Canva