iCare Medicare 
Grievances and Appeals

Medicare Part C (Medicare Advantage) Grievance, Appeals, and Exceptions

Medicare Grievances

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
• inability to obtain culturally and linguistically appropriate services and responsive care

iCare 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 it 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. For more information about grievances and appeals, please see the Evidence of Coverage.

How to file a Grievance

If you have a grievance, you must file your grievance within 60 days of the date of the incident that you are complaining about.  iCare accepts both oral and written grievances. You are encouraged to call Customer Service at 1-800-777-4376 (TTY 1-800-947-3529) to report your grievance. iCare will try to resolve any grievance that you might have over the phone. iCare will notify you in writing within 5 business days that your grievance has been received. If iCare cannot resolve your complaint over the phone, the iCare Grievance and Appeal Coordinator will conduct an investigation.  Members have a right to be heard before the iCare Grievance and Appeal Committee.  At the conclusion of the grievance process, you will receive a letter explaining how iCare resolved your grievance.

If you want your grievance to be in writing, please send it to:

Independent Care Health Plan
Attention: Member Grievances
1555 N. RiverCenter Drive, Suite 206
Milwaukee, WI 53212

OR

Fax: 414-918-7589

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 filed with iCare, please call Customer Service at 1-800-777-4376 (TTY: 1-800-947-3529).

Who can submit grievances, appeals, and exceptions?

You can file a grievance or appeal yourself, your treating physician can file one for you, or someone you name can do it for you. The person you name would be your appointed representative. You can name a relative, friend, advocate, or anyone else to act for you. Some other persons may already be authorized under State law to act for you. If you want someone to act for you, then you and that person must sign and date a CMS Appointment of Representative form (CMS-1696) or an equivalent document and include it with your request for a grievance or appeal. This will give the person you name legal permission to act as your appointed representative. This form must be sent to us at:

Independent Care Health Plan
Attn: Grievance and Appeals Coordinator
1555 N. RiverCenter Dr., Suite 206
Milwaukee, WI 53212

OR 

Fax: 414-918-7589

You can print this form to appoint your representative:

CMS Appointment of Representative form (CMS-1696)

You also have the right to have an attorney file a grievance or appeal on your behalf. You can contact your own lawyer, or get the name of a lawyer from your local bar association or other referral service. There are also groups that will give you free legal services if you qualify.

Medicare Complaint Form

You may also submit feedback or a complaint about your Medicare health plan or prescription drug plan directly to Medicare using the form found at this link:  Medicare Complaint Form.