Explanation required for restriction or termination of coverage

Wis. Stat. § 632.857
in effect
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If an insurer restricts or terminates an insured’s coverage for the treatment of a condition or complaint and, as a result, the insured becomes liable for payment for all of his or her treatment for the condition or complaint, the insurer shall provide on the explanation of benefits form a detailed explanation of the clinical rationale and of the basis in the policy, plan, or contract or in applicable law for the insurer’s restriction or termination of coverage.
Source: WI Statutes (Official Site)URL: https://docs.legis.wisconsin.gov/document/statutes/632.857Fetched: 10/7/2026