Assembly Bill 1128 aims to enhance transparency and accountability in health insurance claims processing by imposing new requirements on insurers. The bill mandates that insurers process claims within a reasonable timeframe to prevent delays in care and provide detailed explanations for any claim denials. Insurers are also required to disclose the use of artificial intelligence or algorithmic decision-making in their claims processes. Additionally, the bill prohibits various practices, such as using vague terms to deny claims, stalling reviews to avoid timely payments, and allowing non-physician personnel to determine medical necessity. Insurers must also publish annual reports on their claim denials and the use of AI in processing claims.

Furthermore, the bill establishes the Office of the Public Intervenor, which will assist individuals with insurance claims and appeals related to medical procedures and medications. This office will have the authority to levy assessments on insurers based on their premium volume and will provide insured individuals with the right to request reviews of claim denials. The bill also grants the commissioner of insurance the power to audit insurers for compliance with these new requirements and to impose corrective actions and penalties for non-compliance. Overall, Assembly Bill 1128 seeks to improve the fairness and transparency of health insurance claims processing in Wisconsin.

Statutes affected:
Bill Text: 15.01(6), 15.01, 20.145(1)(g)1, 20.145, 601.45(1), 601.45