Valued Voice

On Oct. 31, Sen. Rob Hutton (R-Brookfield) and Rep. Robert Wittke (R-Caledonia) circulated legislation to give self-insured employers in Wisconsin a legal right to access their claims data from the insurers and third-party administrators they contract with.  

Hutton and Wittke’s legislation would help pull back the curtain on the pricing practices of insurers and third-party administrators (TPAs), some of whom have blocked employers’ attempts to access their claims data and were later sued by those employers for allegedly violating federal law.

“As it became abundantly clear during the public hearing on 2023 Senate Bill 328 (see WHA testimony here), the lack of transparency between employers, who have been forced to sue their own insurance companies or third-party administrators to get their information, and insurers/TPAs is where lawmakers should focus their concern about lack of enforcement,” said WHA in a June 5, 2025 memo to the Legislature.

WHA has consistently advocated for these insurance industry reforms while strongly opposing misguided state-level hospital price transparency legislation that serves no purpose other than adding another unnecessary, duplicative regulatory burden on Wisconsin hospitals that are already complying with federal hospital price transparency regulations. 

Hutton and Wittke said insurers and third-party administrators’ refusal to provide employers with access to their own health plan data puts them at a distinct disadvantage as they try to manage skyrocketing health insurance premium costs. 

“Some insurers and third-party administrators (TPAs) restrict or severely limit access to claims data and utilization information, making it impossible for businesses to design more cost-effective self-funded plans or shop for alternatives,” wrote Hutton and Wittke in a memo to their legislative colleagues. “Without this data, employers are left in the dark about key cost drivers and opportunities for smarter health plan management.”

Under the bill, insurers and TPAs must provide certain claims data to an employer, also known as the health plan sponsor, within seven business days upon request, including:

• Claims data and payments
• The amounts of fees and discounts
• Itemized billing statements and medical records associated with a specific claim 

Pharmacy benefits managers must provide:

• Prescription drug claims and payments
• Rebate amounts provided by pharmaceutical manufacturers, and the amount of revenue and fees derived from the contract 

In addition, insurers, TPAs and pharmacy benefit managers must provide, upon request, information about claims exceeding or expected to exceed $25,000 or exceeding $10,000 if it is a pharmacy claim.

All existing laws relating to the protection of sensitive personal health information continue to remain in place under the legislation.