Wisconsin Code § 632.857

Explanation required for restriction or termination of coverage
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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.

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