iCare Medicaid SSI and BadgerCare Plus Member Rights & Responsibilities

You have the right to make suggestions about the member rights and responsibilities policy. You, your provider or your designated representative also have the right to receive a copy of iCare’s Member Rights and Responsibilities statement.

If you would like to make suggestions or to receive a copy of this statement contact iCare Customer Service at 1-800-777-4376 (TTY: 711).

iCare provides free aids and services to people with disabilities to communicate effectively with us. We also provide free language services to people whose primary language is not English. If you need these services to communicate with us, contact Customer Service at 1-800-777-4376 (TTY: 711) 24 hours a day, 7 days a week. Our office hours are Monday through Friday, 8:30 a.m. to 5:00 p.m.

About When You May Be Billed for Services

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

About Covered and Non-Covered Services

You do not have to pay for covered services other than required copays. The amount of your copay 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, or believe that you should not have been billed, please call 1-800-777-4376.

Your Member Rights

1. You have a right to get information in a way that works for you. This includes: 

• Your right to have an interpreter with you during any BadgerCare Plus, Medicaid SSI covered service. 
• Your right to get this member handbook in another language or format. 

2. You have a right to be treated with dignity, respect, and fairness and with consideration for privacy. This includes: 

• Your right to be free from discrimination. iCare must obey laws that protect you from discrimination and unfair treatment. iCare provides covered services to all eligible members regardless of the following: 

• Age 

• Color 

• Disability 

• National origin 

• Race 

• Sex 

• Religion 

• Sexual Orientation 

• Gender identity 

All medically necessary, covered services are available and will be provided in the same manner to all members. All persons or organizations connected with iCare that refer or recommend members for services shall do so in the same manner for all members. 

• Your right to be free from any form of restraint or seclusion used to coerce, discipline, be convenient, or retaliate. This means you have the right to be free from being restrained or forced to be alone to make you behave in a certain way, to punish you, or because someone finds it useful. 
• Your right to privacy. iCare must follow laws protecting the privacy of your personal and health information. See iCare’s Notice of Privacy Practices for more information. 

3. You have the right to get health care services as provided for in federal and state law. This includes: 

• Your right to have covered services be available and accessible to you when you need them. When medically appropriate, services must be available 24 hours a day, seven days a week. 

4. You have a right to make decisions about your health care. This includes: 

• Your right to get information about treatment options, regardless of cost or benefit coverage.
• You have the right to be treated with respect and dignity. You also have a right to your privacy. 
• You have the right to have an open and honest talk with iCare and your providers. During this talk you can address what is the best care for your health no matter the cost or benefit coverage. 
• Your right to accept or refuse medical or surgical treatment and participate in making decisions about your care. 
• Your right to plan and direct the types of health care you may get in the future if you become unable to express your wishes. You can make these decisions by completing an advance directive, living will, or power of attorney for health care.  
• Your right to a second opinion if you disagree with your provider’s treatment recommendation. Call Customer Service for more information about how to get a second opinion. 

5. You have a right to know about our providers and any physician incentive plans iCare uses. This includes: 

• Your right to ask if iCare has special financial arrangements (physician incentive plans) 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 and request information about our physician payment arrangements. 
• Your right to request information about iCare providers, including the provider’s education, board certification, and recertification. To get this information, call our Customer Service Department at 1-800-777-4376. 

6. You have a right to ask for copies of your medical records from your provider. 

• You may correct inaccurate information in your medical records if your doctor agrees to the correction. 
• Call 1-800-777-4376 for assistance with requesting a copy or change to your medical records. Please note that you may have to pay to copy your medical records. 

7. You have a right to be informed about any Medicaid covered benefits that are not available through iCare because of moral or religious objection. This includes: 

• Your right to be informed of how to access these services through FowardHealth using your ForwardHealth card. 
• Your right to disenroll from iCare if iCare does not cover a service you want because of moral or religious objections. 

8. You have a right to file a complaint, grievance, or appeal if you are dissatisfied with your care or services. This includes: 

• Your right to request a fair hearing if you are dissatisfied with iCare’s decision about your appeal or if iCare does not respond to your appeal in a timely manner. 
• Your right to request a Department of Health Services grievance review if you are unhappy with iCare’s decision about your grievance or if iCare does not respond to your grievance in a timely manner. 

9. You have the right to receive information from iCare about any big changes with iCare at least 30 days before the effective date of the change. 

10. You have a right to be free to exercise your rights without negative treatment by iCare and its network providers. This includes: 

• Your right to make recommendations about iCare’s Member Rights and Responsibilities Policy. 

Your Responsibilities

Responsibilities means the things you are supposed to do. It also means accepting the positive or negative results of your actions. These are your responsibilities as an iCare member:

• You have the responsibility to provide the information that iCare and its providers need to provide care. 

• You have a responsibility to let iCare know how best to contact and communicate with you. You have a responsibility to respond to communications from iCare. 

• You have a responsibility to follow plans and instructions for care that you have agreed to with your providers. 

• You have a responsibility to understand your health problems and participate in creating treatment goals with your providers. 

IC200 V4 DHS Approved 5/19/23
Last Updated 2/7/24