Medicare Part C Appeals

Medicare Part C Appeals


Appeal: If we make a decision to deny a service or benefit you believe you are entitled to receive you can ask us to rereview the decision. You have 60 calendar days from the date of the denial letter to submit a written request for an appeal.

Two types of Appeals:

Standard: Standard appeal decisions are made no later than 30 calendar days from receiving the request for an appeal. Independent Care may extend the timeframe up to 14 calendar 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 60 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

What Happens Next?

  • Step 1: Within 5 business days you will receive an acknowledgment letter confirming your appeal has been received
  • Step 2: Within 30 business days of receiving your appeal iCare will investigate and make all reasonable efforts to gather additional information relevant to your appeal
  • Step 3: A copy of the appeal file is sent to a third party who was not previously involved in the decision making process for review
  • Step 4: If the third party review determines iCare made an incorrect decision, iCare will authorize the service in dispute
  • Step 5: If the third party review determines iCare made the correct decision, the appeal file is forwarded to an independent reviewer hired by Medicare to make a final decision
  • You will receive written notification of the final decision

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.

If you need assistance filing an appeal, contact iCare’s Quality Improvement Specialist at 414-225-4733 or a Member Advocate at 414-231-1076.


Modified: 2/21/2018

H2237_IC1770 Pending CMS Approval

 

Independent Care Health Plan (iCare) is a Medicare Advantage HMO SNP organization with a Medicare contract and a contract with the State Medicaid program. Enrollment in any iCare plan depends on contract renewal. Plans are available to anyone who has both Medical Assistance from the State and Medicare. 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.

  • 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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