Part C Grievance Policy

Part C Grievance Policy


What is a Grievance?

A grievance is any complaint other than one that involves a coverage determination. You may file a grievance if you have any type of problem with one of Independent Care Health Plans's Medicare plans or one of our network pharmacies that does not relate to coverage or a payment decision for a prescription drug. To obtain an aggregate number of grievance, appeals and exceptions filed with iCare, contact us at 1-800-777-4376.

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

  • You feel that you are being encouraged to leave (disenroll from) one of our Medicare plans
  • 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 pharmacists or other staff
  • Cleanliness or condition of pharmacy
  • 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
  • Failure to give you a decision within the required timeframe
  • Failure to forward your case to the Independent Review Entity if we do not give you a decision within the required timeframe
  • Failure by the Plan to provide required notices
  • Failure to provide required notices that comply with CMS standards

How to File a Grievance

If you have a grievance, we encourage you to first call Customer Service at 1-800-777-4376 (TTY 1-800-947-3529). We will try to resolve any complaint that you might have over the phone. If you request a written response to your phone complaint, we will respond in writing to you. If we cannot resolve your complaint over the phone, write us at:

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

OR FAX:
414-231-1092

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.

We must notify you of our decision about your grievance as quickly as your case requires based on your health status, but no later than 30 calendar days after receiving your complaint. We may extend the timeframe by up to 14 calendar days if you request the extension, or if we justify a need for additional information and the delay is in your best interest.

If you would like to inquire about the status of a grievance, please call Customer Service at 1-800-777-4376 (TTY 1-800-947-3529).

See your Evidence of Coverage, Chapter 9, Section 11 if you have a complaint (grievance), for more information.

Ombudsman

The Medicare Ombudsman is also available to assist you with complains, grievances, and information requests.


Modified: 7/24/2017
 

  • H2237_IC1453 Approved
 
  • 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 © 2017 Independent Care Health Plan