If you are asking to appeal a decision for your Family Care Partnership benefits, an appeal request can be made either orally or in writing. An oral filing must be followed up with a written request. verbal or written requests must be received within 45 calendar days from the date of the denial letter.
Two types of Appeals:
Standard: Standard appeal decisions are made no later than 20 business days from receiving the request for an appeal. Independent Care may extend the timeframe up to 10 business days if you request the extension or if iCare is able to justify that an extension is in your best interest.
Standard appeals must be submitted within 45 calendar days from the date on the denial notice by writing to:
- Quality Improvement Specialist
- Independent Care Health Plan
- 1555 N. RiverCenter Dr. Ste. 206
- Milwaukee, WI 53212-3958
iCare Member Rights Specialist can inform you of your rights, attempt to informally resolve your concern, and assist you with filing an appeal. He or she cannot represent you at a State fair hearing. To contact our iCare’s Member Rights Specialist, call 414-231-1076.
The following independent ombudsman agencies may be able to provide you with free assistance. These agencies advocate for Family Care Partnership members.
- For members age 18 to 59:
- Disability Rights Wisconsin Family Care and IRIS Ombudsman Program
- Call the office closest to you:
- Toll Free Madison: (800) 928-8778
- Milwaukee: (800) 708-3034
- Rice Lake: (877) 338-3724
- TTY (888) 758-6049
- For members age 60 and older:
- Wisconsin Board on Aging and Long Term Care
- Toll Free (800) 815-0015
What Happens Next?
- Step 1: Within 10 business days you will receive an acknowledgment letter confirming your appeal has been received
- Step 2: Within 20 business days of receiving your appeal iCare will investigate and make all reasonable efforts to gather additional information relevant to your appeal
- Step 3: An Appeal Committee meeting is scheduled. Members are encouraged to attend the appeal meeting and speak with the Committee
- Step 4: After the committee reviews all of the information, and speaks to the member, a decision is made to either approve or deny the benefit
- Step 5: If the Committee determines to approve the service, iCare will authorize the service in dispute
- Step 6: If the committee determines to deny the benefit, you can ask the state to review the denial or request a Fair Hearing
Department of Health Services Review
You may also choose to have this decision reviewed by MetaStar, the Department of Health Services’ external quality review organization. MetaStar will try to resolve your concerns informally. You can request to have your services continued during the review, if you request the review on or before the effective date of the intended action. If you request a state fair hearing, MetaStar will automatically review your appeal. Please note, however, that MetaStar cannot require any MCO to change its decision.
To request that MetaStar review your case immediately or to learn more about a MetaStar review, call 1-888-203-8338. You may also request a MetaStar review by mail, fax, or email.
- DHS Family Care and Partnership Grievances, C/O MetaStar
- 2909 Landmark Place
- Madison, WI 53713
- Fax: (608) 274-8340
- E-mail MetaStar at dhsfamcare@wisconsin.gov
You could also choose to request a fair hearing with the State of Wisconsin’s Division of Hearings and Appeals, you will have a hearing with an independent judge. You may bring an advocate, friend, family member or witnesses. You may also present evidence at this hearing. If you request a State Fair Hearing, your appeal will automatically go through a Department of Health Services review.
To file a request for a fair hearing, you can ask for a hearing and/or a hearing form from the Member Rights Specialist at 414-231-1076. You can also request a hearing form from one of the independent ombudsman agencies listed or you can go online and get a form at:
http://dhs.wisconsin.gov/forms/f0/f00236.doc
You can send the completed request form or a letter asking for a hearing and a copy of this notice to:
- Family Care Request for Fair Hearing, c/o Wisconsin Division of Hearings and Appeals
- 5005 University Ave. #201
- Madison, WI 53705-5400
- or
- Fax: 608-264-9885
Expedited (fast) Appeal: You can ask for an expedited appeal if you feel your health could be in jeopardy by waiting the standard timeframe. Expedited appeals are decided within two business days. Expedited appeals can be transferred to the standard timeframe if it is determined your life is not in serious jeopardy.
Expedited appeals follow the same steps as a standard appeal, however the process will be completed within 72 hours from receiving the appeal request.