Part C Grievance Policy

FCP Complaints and Grievances Policy


Option 1: File a complaint or grievance with iCare Family Care Partnership directly

Any FCP member or authorized representative can file a complaint or grievance about care or services received from iCare or a provider arranged or paid by iCare. iCare treats all complaints as grievances. This means that we will keep track of member complaints, take your concerns seriously and make sincere efforts to resolve them.

Grievances can be submitted to iCare either orally or in writing. The iCare Family Care Partnership program has a Member Rights Specialist available to help members with grievances. If the grievance cannot be resolved informally, members have a right to be heard before the iCare Grievance Committee. Members also have the option to be represented by an advocate, peer or representative during the grievance process. A member representative is also part of the Committee, but this can be waived by a member. Grievances submitted to iCare are resolved within 20 business days of receipt. One extension of 14 days may be allowed if it is in the best interest of the member.

Members may request an expedited (fast) decision on grievances if the normal time frame would jeopardize the member’s life, health or ability to attain, maintain or regain maximum function. If a request to expedite a grievance resolution is granted, iCare must resolve the complaint within 72 hours unless an extension of 14 days is requested in writing. If you have additional evidence you want us to consider, you will need to submit it quickly.

The address and telephone number for filing grievances or complaints is:

  • Member Rights Specialist
  • Independent Care Health Plan
  • 1555 North RiverCenter Drive
  • Suite 206
  • Milwaukee, WI 53212
  • (414) 231-1076
  • Toll Free: (800)777-4376
  • TTY: Call the Wisconsin Relay System at 711

Option 2: DHS Grievance Process:

A member may submit a grievance to DHS before, during or after submitting the grievance to iCare. The Member Rights Specialist can assist with this process. If you choose this option, DHS will work with an outside reviewing agency (currently Metastar) to resolve your complaint. The outside agency will not issue a decision, but will work with DHS and iCare to be sure that your complaints are acceptably resolved. If you do not agree with this resolution, you can still file a grievance with iCare directly.

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:

We cannot treat you in a different way because you file a complaint. Your health care benefits will not be affected. We will provide all non-English speaking and hearing-impaired members with interpreter services during the grievance process.

If you need assistance in filing an appeal you can contact iCare’s Member Rights Specialist at 414-231-1076.

The following independent ombudsman agencies are also available to assist free of charge.

  • 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

Modified: 2/21/2018

H2237_IC1770 Pending CMS Approval

 

The iCare Family Care Partnership (HMO SNP) is a Coordinated Care plan with a Medicare contract and a contract with the State Medicaid program. Enrollment in iCare Family Care Partnership depends on contract renewal. This plan is available to anyone who has both Medical Assistance from the State and Medicare and functionally eligible as determined by the State of Wisconsin Long-Term Care Functional Screen. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The Part B premium is covered by the State if you are a full-dual member. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. You must receive all routine care from plan providers. For more information about Medicare benefits and services, including general information regarding the health or Part D benefit, contact 1-800-MEDICARE (1-800-633-4227) or visit http://www.medicare.gov; TTY users should call 1-887-486-2048, 24 hours a day, 7 days a week. For more information about State Medicaid benefits call the Department of Health Services at 1-800-362-3002 (TTY 1-888-701-1251) or visit http://dhs.wisconsin.gov/medicaid. For more information about long-term care options available to you in your county contact the Aging and Disability Resource Centers. The Resource Center can also assist you with information about eligibility and enrollment.

  • H2237_IC1770 CMS Approval
 
  • Independent Care Health Plan
  • 1555 RiverCenter Drive, Suite 206
  • Milwaukee, WI 53212
  • Customer Service: 1-800-777-4376
    • 24 hours-a-day, 7 days-a-week
    • (Office Hours: Monday-Friday, 8:30 a.m. to 5:00 p.m.)
  • TTY: 1-800-947-3529
  • Fax: 414-231-1092
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  • Copyright © 2018 Independent Care Health Plan