Sen. Mark Spreitzer, Rep. Clinton Anderson Propose Protections Against Unfair Medical Billing and Insurance Clawbacks

FOR IMMEDIATE RELEASE
March 9, 2026
Contact: Sen. Mark Spreitzer, 608-266-2253
Rep. Clinton Anderson, 608-237-9145

BELOIT - Today, State Senator Mark Spreitzer and Representative Clinton Anderson introduced LRB-1350, which would protect Wisconsin healthcare providers and patients from unfair retroactive claim denials by insurance companies.

Currently, insurers can demand repayment for a patient’s care years after initially approving a claim. This forces providers to either bill other insurance years later, pass the cost directly to the consumer, or - as is usually the case - take on the financial burden themselves. These costs can quickly mount and can be particularly challenging for small, stand-alone mental health providers who do not have the resources on hand to cover them. LRB-1350 creates a reasonable timeline for these clawbacks - limiting them to 12 months in normal circumstances or 18 months if coordinating with a third-party payer. This would bring Wisconsin in line with 38 other states which already offer these protections.

Senator Mark Spreitzer (D-Beloit)

“During a roundtable discussion with patients and healthcare providers from Rock County, I heard loud and clear that unexpected insurance clawbacks happening years after treatment are actively hurting our local clinics, threatening healthcare access for patients who have complex needs that rely on only a handful of providers in any given part of the state. No provider should face a financial crisis because an insurance company changes their determination years after approval and payment are given. It should not take years to catch a clerical mistake. This common-sense legislation puts a reasonable time limit in place on retroactive claim denials, providing much-needed certainty and fairness for Wisconsin providers and patients.”

Representative Clinton Anderson (D-Beloit)

“This bill is about fairness for both patients and providers. When an insurance company approves and pays a claim, health care providers and patients should be able to rely on that decision. Too often insurers come back years later claiming they made a mistake and demand the money back. That leaves providers, especially small independent practices like mental health counselors, stuck with unexpected costs or forces patients to revisit bills they thought were already settled. Insurance company errors should not become financial burdens for patients or providers. Thirty-eight other states already have limits like this in place, and Wisconsin should join them in supporting our providers and protecting patients.”