Members

Member Advocacy


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.

Advice, Records, Exemptions and Advanced Directives

Second Medical Opinion

If you disagree with your doctor’s treatment recommendations, you may be able to get a second medical opinion. Contact your doctor or our Customer Service Department at 1-800-777-4376 for information.

Right to Medical Records

You have the right to ask for copies of your medical record from your provider(s). We can help you get copies of these records. Please call 1-800-777-4376 for help. Please note: You may have to pay for copies of your medical record. You also may correct wrong information in your medical records if your doctor agrees to the correction.

HMO Exemptions

An HMO exemption means you are not required to join an HMO to receive your health care benefits. Most exemptions are granted for only a short period of time so you can complete a course of treatment before you are enrolled in an HMO. If you think you need an exemption from HMO enrollment, call the HMO Enrollment Specialist at 1-800- 291-2002 for more information.

Completing an Advance Directive, Living Will, or Power of Attorney for Health Care

You have a right to accept or refuse medical or surgical treatment. You also have a right to plan and direct the types of health care you may receive in the future if you become unable to express your wishes. You can let your doctor know about your feelings by completing a living will or power of attorney for health care form. Contact your doctor for more information.

You have the right to file a grievance with DHS, Division of Quality Assurance, if your advance directive, living will or power of attorney wishes are not followed. You may request help in filing a grievance.

Billing Questions

When You May Be Billed For Services

It is very important to follow the rules when you access medical care so you are not billed for services. You must get your care from iCare network doctors, clinics, and hospitals unless you have our approval. The only exception is for severe emergencies.

If you travel outside of Wisconsin and need emergency services, health care providers can treat you and send claims to iCare. You may have co-payments for emergency services provided outside Wisconsin, but the charges for Medicaid covered services will be no more than charges for services in the network. You will have to pay for any service you get outside Wisconsin if the health care provider refuses to submit claims or refuses to accept iCare payment as payment in full.

Billing Members

Covered and Non-Covered Services

Under Medicaid SSI/BadgerCare Plus, you do not have to pay for covered services other than required copayments. The amount of your co-pay cannot be greater than it would have been in fee-for-service. To help ensure that you are not billed for services, you must see a provider in iCare’s network. The only exception is for emergencies. If you are willing to accept financial responsibility and make a written payment plan with your provider, you may ask for noncovered services. Providers may bill you up to their usual and customary charges for noncovered services. If you get a bill for a service you did not agree to, please call 1-800-777-4376.

Co-Payments

Under Medicaid SSI/BadgerCare Plus, iCare and its providers and subcontractors may bill you for small service fees, called co-payments. The following members do not have to pay co-payments:

  • Medicaid SSI members
  • Nursing home residents
  • Pregnant women
  • Members under 19 years of age who are members of a federally recognized tribe
  • Members under 19 years of age with incomes at or below 100 percent of the Federal Poverty Level (FPL)
Medical Services Received Outside Wisconsin

If you travel outside Wisconsin and need emergency care, health care providers in the area where you travel can treat you and send the bill to iCare. You may have copayments for emergency services provided outside Wisconsin.

iCare does not cover any services, including emergency services, provided outside 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 U.S. bank. Please call iCare if you get any emergency services outside the United States.

If you get a bill for services, call our Customer Service Department at 1-800-777-4376 right away.

Other Insurance

If you have other insurance in addition to iCare, you must tell your doctor or other provider. Your health care provider must bill your other insurance before billing iCare. If your iCare network doctor does not accept your other insurance, call the HMO Enrollment Specialist at 1-800-291-2002. The Enrollment Specialist can tell you how to match your HMO enrollment with your other insurance so you can use both insurance plans.

Provider Payment Credentials and Clinical Practice Guidelines

Knowing About The Physician Incentive Plan

You are entitled to ask if we have special financial arrangements with our physicians that can affect the use of referrals and other services you might need. To get this information, call our Customer Service Department at 1-800-777-4376 (TTY 1-800-947-3529) and request information about our physician payment arrangements.

Knowing Provider Credentials

You have the right to information about our providers that includes the provider's education, board certification and recertification. To get this information, call our Customer Service Department at 1-800-777-4376.

Clinical Practice Guidelines

Independent Care has implemented our Clinical Practice Guidelines with the support of network physicians on our review committee. Each clinical practice guideline represents an accepted standard of care in the medical profession that may be used for diagnosing, managing or treating conditions like asthma, COPD, diabetes, hypertension, obesity and drug and alcohol treatment. None of the information within these guidelines is intended to interfere with decisions made by your treating physician about your care. You can receive a hard copy of our practice guidelines by contacting your Care Coordinator or by visiting our website at http://www.icare-wi.org.

Helpful Contacts

Automated Health Systems
633 West Wisconsin Avenue, Suite 301
Milwaukee, WI 53203

Your Member Rights

  • You have the right to ask for an interpreter and have one provided to you during any Medicaid SSI/BadgerCare Plus covered service.
  • You have the right to receive information provided in this member handbook in another language or another format.
  • You have the right to receive health care services as provided for in federal and state law. All covered services must be available and accessible to you. When medically appropriate, services must be available 24 hours a day, seven days a week.
  • You have the right to receive information about treatment options including the right to request a second opinion.
  • You have the right to make decisions about your health care.
  • You have the right to be treated with dignity and respect.
  • You have the right to be free from any form of restraint or seclusion used as means of force, control, ease or reprisal.

Your Civil Rights

Independent Care provides covered services to all eligible members regardless of the following

  • Age
  • Race
  • Color
  • Disability
  • Sex
  • National Origin

All medically necessary covered services are available to all members. All services are provided in the same manner to all members. All persons or organizations connected with iCare who refer or recommend members for services shall do so in the same manner for all members. Translating or interpreting services are available for those members who need them.

This service is free.

Privacy

We are firmly committed to protecting the confidentiality of your personal and health related information. Review our privacy statement for more detail.

The Five Steps to Patient Safety

Get information on how to reduce errors in your health care.

Notification:
By clicking the links above, you may be leaving the icare-wi.org website. Independent Care Health Plan (iCare) only provides these links and pointers for your information and convenience. When you select a link to an outside website, you are leaving the iCare.wi.org website. These external links are not the responsibility of, or under the control of iCare. Independent Care Health Plan disclaims responsibility for the content and privacy policies of the owners/sponsors of the outside websites.

 

 
 
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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.