Part C Grievance Policy For Medicaid And BadgerCare

Medicaid SSI & BadgerCare Plus Complaint and Grievance Policy


iCare’s Member Advocate

Independent Care has a Member Advocate to help you get the care you need. The Advocate can answer your questions about getting health care from iCare. The Advocate can also help you solve any problems you may have getting health care from iCare. You can reach the Advocate at 1-800-777-4376 or 414-231-1076.

State of Wisconsin Ombuds Program

The state has designated Ombuds (individuals who provide neutral, confidential and informal assistance) who can help you with any questions or problems you have as an HMO member. The Ombuds can tell you how to get the care you need from iCare. The Ombuds can help you solve problems or complaints you may have about iCare. Call 1-800-760-0001 to ask to talk to an Ombuds.

What is a Grievance?

A grievance is any expression of dissatisfaction by a member or member’s authorized representative about:

  • iCare services or procedures
  • a contracted provider’s services or procedures
  • services arranged by iCare or a contracted provider

iCare will treat every complaint as a grievance. This means that we will keep track of member complaints, take your concerns seriously and make sincere efforts to resolve them.

Dissatisfaction with a determination of coverage is not considered a grievance, but may be treated as an appeal. It is iCare’s responsibility to determine whether your complaint is a grievance or an appeal, or has pieces of both.

What types of problems might lead to you filing a grievance?

  • Problems with the member service you receive
  • Problems with how long you have to spend waiting on the phone or in the pharmacy
  • Disrespectful or rude behavior by iCare or a provider’s staff
  • Cleanliness or condition of an office or facility
  • If you disagree with our decision not to expedite your request for an expedited coverage determination or redetermination
  • You believe our notices and other written materials are difficult to understand
  • iCare does not notify you of a decision within the required time frame
  • iCare does not give you proper notice of your rights and/or responsibilities
  • Delays in service or delivery of DME by a contracted provider

We would like to know if you have a complaint about your care at iCare. Please call iCare’s Member Advocate at 1-800-777-4376 (TTY 1-800-947-3529), fax us at 1-414-231-1092 or write us at:

  • Independent Health Care Plan
  • 1555 N. RiverCenter Dr., Suite 206
  • Milwaukee, WI 53212

If you want to talk to someone outside of iCare about the problem, call the HMO Managed Care Ombudsman at 1-800-760-0001. The Ombudsman may be able to help you solve the problem, or can help you write a formal complaint to iCare or to the BadgerCare Plus/Medicaid SSI program.

The address to complain to the Medicaid SSI program is:

  • Medicaid SSI Managed Care Ombuds
    • P.O. Box 6470
    • Madison, WI 53716-0470
    • Phone: 1-800-760-0001

The address to file a complaint with the BadgerCare Plus program is:

  • BadgerCare Plus Managed Care Ombuds
    • P. O. Box 6470
    • Madison, WI 53716-0470
    • Phone: 1-800-760-0001

If your complaint or grievance needs action right away because a delay in treatment would greatly increase the risk to your health, please call iCare as soon as possible at 1-800-777-4376.

We cannot treat you different than any other members because you file a complaint. Your health care benefits will not be affected.

Modified: 2/21/2018
 

  • 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
  • All content and images unless otherwise indicated are
  • Copyright © 2018 Independent Care Health Plan