What is a Grievance?
A grievance is any expression of dissatisfaction by a member or member’s authorized representative about:
- iCare services or procedures
- a contracted provider’s services or procedures
- services arranged by iCare or a contracted provider
Independent Care Health Plan treats every complaint as a grievance. This means that iCare will keep track of member complaints, take your concerns seriously and make sincere efforts to resolve them.
Dissatisfaction with a determination of coverage is not considered a grievance, but may be treated as an appeal. It is iCare’s responsibility to determine whether your complaint is a grievance or an appeal, or has pieces of both.
How to file a Grievance?
If you have a grievance, you are encouraged to call Customer Service at 1-800-777-4376 (TTY 1-800-947-3529). Independent Care Health Plan will try to resolve any complaint that you might have over the phone. iCare will notify you in writing within 10 business days that your grievance has been received. If iCare cannot resolve your complaint over the phone, the Quality Improvement department will conduct an investigation. At the conclusion of the investigation, you will receive a letter explaining how iCare resolved your grievance.
If you want your grievance to be in writing (this is not required for standard grievances), please send it to:
Independent Care Health Plan
Attention: Member Grievances
1555 N. RiverCenter Dr., Suite 206
Milwaukee, WI 53212
If you want a fast (expedited) decision about your grievance, you must ask for it in writing. iCare will resolve expedited grievances within 3 business days. If iCare decide that your condition does not require a fast (expedited) decision, iCare will notify you in writing that it has been transferred to the standard time frame. You have the right to appeal a determination that iCare makes denying a fast (expedited) decision.
iCare 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. 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.
iCare cannot treat you in a different way because you file a complaint. Your health care benefits will not be affected. iCare will provide all non-English speaking and hearing-impaired members with interpreter services during the grievance process.
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).
The Medicare Ombudsman is also available to assist you with complains, grievances, and information requests.
You can also contact iCare’s Member Advocate/Member Rights Specialist at 414-231-1076 for assistance.
Medicare Complaint Form
You are now able to submit feedback about your Medicare health plan or prescription drug plan directly to Medicare using the form found at www.medicare.gov/MedicareComplaintForm/home.aspx.