Members

How to Use iCare Medicaid SSI Services


Now that you are a member of iCare, we would like to let you know how to use the services we have to offer.

Your Care Coordinator

With iCare Medicaid SSI, Care Coordinators help you with medical, dental, behavioral health and vision through a process called care coordination. Care coordination takes into account that both medical and social needs must be met in order to improve your quality of life.

Within 60 days of enrollment we will complete an assessment with you to help understand your health needs and goals. We will develop a plan of care based on the assessment, which we will share with you and your Primary Care Provider (PCP).

Primary Care Physician-PCP

You are required to have a Primary Care Physician assigned to you. It is important to call your primary care physician first when you need care. This doctor will manage all your health care. If you think you need to see another doctor or a specialist, ask your PCP. Your PCP will help you decide if you need to see another doctor and give you a referral. Some specialty services require a referral, some do not. Your doctor knows when a referral is needed. You can choose your primary care physician (PCP) from those available in the iCare Medicaid SSI Provider Directory.

NOTE: For women, you may also see a women’s health specialist (for example, an OB/GYN doctor or a nurse midwife) without a referral, in addition to choosing your PCP. There are HMO doctors who are sensitive to the needs of many cultures. We can assist you to find one (you can change your PCP up to two times a year, more often with good cause.) A specialist can serve as PCP, if necessary. To choose a PCP, or to change to a different PCP, call your Care Coordinator or our Customer Service Department at 1-800-777-4376.

Referrals and Prior Approvals

Referrals are required for out of area providers, and all second (or additional) opinions.

Prior authorizations also are required for certain surgeries and other types of care. Your PCP will know when you need a referral and/or prior authorization. If you do not receive a referral for the above services, talk to your PCP or call iCare Customer Service at 1-800-777-4376 (TTY 1-800-947-3529).

Your ForwardHealth Card

Your ForwardHealth card is how your doctor will know you are a Medicaid SSI member. Always carry your ForwardHealth card with you, show it every time you get care and tell your doctor that you belong to iCare. You may have problems getting care or prescriptions if you do not have your card with you. Also bring any other health insurance cards you may have.

In addition, please have your ForwardHealth card and your ID number available when you call Customer Service. We need this in order to look up your benefit information.

Emergency Care

Emergency care is care needed right away. This may be caused by an injury or a sudden illness. Some examples are:

  • Serious broken bones
  • Suspected heart attack
  • Unconsciousness
  • Suspected stroke
  • Severe burns
  • Convulsions
  • Severe pain
  • Prolonged or repeated seizures
  • Choking
  • Severe or unusual bleeding
  • Trouble breathing
  • Suspected poisoning

If you need emergency care, go to an iCare provider for help if you can. BUT if the emergency is severe, go to the nearest provider (hospital, doctor or clinic). You may want to call 911 or your local police or fire department emergency services if the emergency is severe.

If you must go to a non-iCare hospital or provider, call iCare at 1-800-777-4376 as soon as you can and tell us what happened. This is important, so we can help you get follow-up care.

Remember, hospital emergency rooms are for true emergencies only. Call your doctor or our 24-hour emergency number at 1-800-777-4376 before you go to the emergency room, unless your emergency is severe.

What to Expect When You Access Emergency Services

When you get to the hospital, a nurse may ask about your symptoms, take your blood pressure, temperature and pulse, ask when you last ate or drank, and ask you about your medical history. You may not feel like answering questions, but the information will help provide you with the best possible emergency care. Patients with the most serious needs are treated first in the emergency room. After you are treated, you may be: asked to contact your physician, admitted to the hospital or discharged with written instructions. If you are prescribed medications, make sure you ask the nurse or doctor:

  • What the medication is
  • When to take the medication
  • How much medication to take
  • How long to take the medication
  • About possible side effects and what to do if you notice them
  • Do not be afraid to ask questions if you do not understand something. It’s important that you know how to take care of yourself when you return home. If you have a friend or relative with you, make sure they hear the health care provider’s instructions as well.

    Post-stabilization services are medically necessary non-emergency services given to you after you have been stabilized following an emergency medical condition. Post-stabilization care services are a covered benefit, but they may require authorization. For more information about accessing these services, you can call iCare 24 hours a day at 1-800-777-4376.

    Accessing Urgent Care

    Urgent Care is care you need sooner than a routine doctor's visit. Urgent care is not emergency care. Do not go to a hospital emergency room for urgent care unless your doctor tells you to go there. Some examples of urgent care are:

    • Most broken bones
    • Minor cuts
    • Sprains
    • Bruises
    • Non-severe bleeding
    • Most drug reactions
    • Minor burns

    If you need urgent care, call iCare Customer Service at 1-800-777-4376 (TTY 1-800-947-3529). We will tell you where you can get care. You must get urgent care from iCare network providers unless you get our approval to see a provider that is not with iCare.

    Remember, do not go to a hospital emergency room for urgent care unless you get approval from your PCP first.

    After-Hours Service

    For after-hours urgent or emergent care inquiries, please call us at 1-800-777-4376 (TTY 1-800-947-3529) or 414-223-4847, and follow the prompts to get you in contact with a member of the care management team.

    Getting Medical Care When You Are Away from Home

    Follow these rules if you need medical care but are too far away from home to go to your PCP or clinic.

    For severe emergencies, go to the nearest hospital, clinic, or doctor. For urgent or routine care away from home, you must get approval from us to go to a different doctor, clinic or hospital. This includes young adults who are spending time away from home with a parent or relative. Call iCare at 1-800-777-4376 for approval to go to a different doctor, clinic or hospital.

    Care Outside of Wisconsin

    If you travel outside of Wisconsin and need emergency services, health care providers can treat you and send claims to iCare. You will have to pay for any service you get outside the state if the health care provider will not submit claims or accept iCare’s payment as payment in full.

    Emergency Services Outside the U.S.

    Independent Care Health Plan does not cover any service, including emergency services, provided outside of the United States, Canada and Mexico. If you need emergency services while in Canada or Mexico, iCare will cover the service only if the doctor’s or hospital’s bank is in the United States. Other services may be covered with HMO approval, if the provider has a United States bank. Please call iCare if you receive any emergency services outside of the United States.

    If You Move

    If you are planning to move, contact your county Department of Social or Human Services. If you move to a different county, please note that you must also contact the Department of Social or Human Services in your new county to update your eligibility. If you move out of the iCare service area, call the MCO Enrollment Specialist at 1-800-291-2002. The Enrollment Specialist will help you choose an HMO that serves your area.

    Here are some helpful phone numbers for you to call regarding moves and address changes:

    • Milwaukee County Change Center: (414) 289-6000
    • Adams County: (608) 339-4505
    • Brown County: (920) 448-6000
    • Calumet County: (920) 849-1400
    • Dane County: (608) 242-6424
    • Dodge County: (920) 386-3750
    • Door County: (920) 746-7155
    • Fond du Lac County: (920) 929-3400
    • Grant County: (608) 723-2136
    • Green County: (608) 328-9393
    • Jackson County: (715) 284-284-4307 ext 306
    • Jefferson County: (920) 674-3105
    • Juneau County: (608) 847-2400
    • Kenosha County: (262) 697-4500
    • Kewaunee County: (920) 388-7030
    • La Crosse County: (888) 627-0430
    • Manitowoc County: (920) 683-4230
    • Marinette County: (715) 732-7700
    • Monroe County: (608) 269-8600
    • Oconto County: (920) 834-7000
    • Outagamie County: (920) 832-5178
    • Ozaukee County: (262) 284-8200
    • Racine County: (262) 638-6353
    • Sauk County: (608) 355-4200
    • Shawano County: (715) 526-4700
    • Sheboygan County: (920) 459-6400
    • Trempealeau County: (715) 538-2311 ext. 290
    • Vernon County: (608) 637-5210
    • Walworth County: (262) 741-3200
    • Washington County: (262) 335-4610
    • Waupaca County: (715) 258-6300
    • Winnebago County: (920) 236-4600
    • Waukesha County: (262) 548-7280

    You should also contact the Social Security Administration if you have SSI or Medicare.

    • Social Security Recipient Services hotline at 1-800-362-3002
    • Social Security Administration: 1-800-772-1213

 

  
 
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Call 1-800-777-4376 (TTY: 1-800-947-3529), from 8:00 a.m to 8:00 p.m.,
7 days-a-week, for further information about iCare.