You cannot request a State Fair Hearing until you have exhausted all of your appeal rights with iCare. If iCare does not make a determination on your appeal within the time frames indicated below, you are deemed to have exhausted iCare’s appeal process and you can then file a fair hearing.
Two Types of Appeals
Standard: iCare makes standard appeal decisions no later than 30 calendar days from receiving the written request for an appeal. iCare may extend the timeframe by up to 14 calendar days if you request the extension, or if iCare is able to justify a need for additional information and the delay is in your best interest.
Expedited (Fast) Appeal: You can ask for an expedited appeal if you feel your life or health could be in jeopardy by waiting the standard timeframe. Expedited appeals can be transferred to the standard timeframe if it is determined your life or health is not in serious jeopardy. If the request for a fast appeal is denied, you will be notified in writing of your right to file a grievance.
If iCare agrees that your appeal should be expedited, it will follow the same steps as a standard appeal, except that the appeal process will be completed within 72 hours from receiving the appeal request. iCare may extend the timeframe by up to 14 calendar days if you request the extension, or if iCare is able to justify a need for additional information and the delay is in your best interest.
Appeals must be submitted within 60 calendar days from the date on the iCare denial notice by writing to:
Grievance and Appeal Coordinator
Attention: Member Appeals
Independent Care Health Plan
1555 N. RiverCenter Dr., Suite 206
Milwaukee, WI 53212-3958
What Happens Next
Within 30 calendar days of receiving your appeal (or an additional 14 days if there has been an extension), iCare will make a decision about your appeal and you will receive written notice of our decision. If we determine we made an incorrect decision, iCare will authorize the services. If we determine we were correct to deny your services, you can then ask for a State Fair Hearing.
Once you have exhausted iCare’s appeal process, if you are still not happy with iCare’s decision, you can ask for a State Fair Hearing by sending a written request to:
Department of Administration
Division of Hearings and Appeals
P.O. Box 7875
Madison, WI 53707
If you need a special arrangement for a disability or language translation, please call 1- 608-266-3096 (voice) or 1-608-264-9853 (hearing impaired). If you choose to request a Fair Hearing with the State of Wisconsin’s Division of Hearings and Appeals, you will have a hearing with an independent judge. You may bring an advocate, friend, family member or witnesses. You may also present evidence at this hearing. If you request a State Fair Hearing, your appeal will automatically go through a Department of Health Services review.
Help with Understanding Your Rights, or Help with Filing a Grievance or Appeal
iCare has a Member Advocate that can help you understand your rights and/or help you file a grievance or appeal. The iCare Member Advocate contact information is below:
Independent Care Health Plan
1555 North RiverCenter Dr., Suite 206
Milwaukee, WI 53212
Toll Free: 800-777-4376
You may also contact the following resources for information or assistance: