Part C Grievance Policy For Medicaid And BadgerCare

Part C Medicaid SSI & BadgerCare 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.

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. 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.

Complaints, Grievances and Appeals

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 Enrollment Specialist at 1-800-291-2002. The Enrollment Specialist 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.

You have the right to appeal to the State of Wisconsin Division of Hearings and Appeals (DHA) for a fair hearing if you believe your benefits are wrongly denied, limited, reduced, delayed or stopped by iCare. An appeal must be made no later than 45 days after the member receives notice of action about the decision being appealed. If you make an appeal before the effective date, the service may continue. You may need to pay for the cost of services if the hearing decision is not in your favor. If you want a fair hearing, send a written request to:

  • Department of Administration Division of Hearings and Appeals
  • P.O. Box 7875
  • Madison, WI 53707-7875

The hearing will be held with an administrative law judge in the county where you live. You have the right to bring a friend or be represented at the hearing. If you need a special arrangement for a disability, or for English language translation, please call 608-266-3096 (voice) or 608-264-9853 (hearing impaired).

We cannot treat you differently than other members because you request a fair hearing. Your health care benefits will not be affected. If you need help writing a request for a fair hearing, please call the BadgerCare Plus or Medicaid SSI Ombuds at 1-800-760-0001 or the HMO Enrollment Specialist at 1-800-291-2002.

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