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

 

Knowing About Physician Incentive Plan

You have the right 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 and request information about our physician payment arrangements.

Knowing Provider Credentials

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

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

You have the right to make decisions about your medical care. You have the right to accept or refuse medical or surgical treatment. You have the 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 let your doctor know about your wishes by completing an advance directive, living will, or power of attorney for health care. Contact your doctor for more information.

You have the right to file a grievance with the 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.

Transition of Care

If you have moved from ForwardHealth or a BadgerCare Plus HMO to a new BadgerCare Plus HMO, then you have the right to:

• Continue to see your current providers and access your current services for up to 90 days. Please call your HMO upon enrollment to let them know who your provider is. If this provider is still not in the HMO network after 90 days, you will be given a choice of participating providers to make a new choice.
• Receive services that would pose a serious health risk or hospitalization if you did not receive them.

Right to Medical Records

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

HMO Moral or Religious Objection

The HMO will inform members of any covered Medicaid benefits which are not available through the HMO because of an objection on moral or religious grounds. iCare will inform members about how to access those services through the State.

Your Member Rights

 

• You have the right to have an interpreter with you during any BadgerCare Plus or Medicaid SSI covered service.
• You have the right to get the information provided in this member handbook in another language or format.
• You have the right to get 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 get information about treatment options including the right to request a second opinion.
• You have the right to make decisions about your health care. You also have the right to participate with your providers in making decisions about your health care.
• 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.
• You have the right to be treated with respect and dignity. You also have a right to your privacy. (iCare's Privacy Statement can be found here.)
• You have the right to be free from any form of restraint or seclusion used as a means of force, control, ease, or reprisal.
• You have the right to be free to exercise your rights without adverse treatment by the HMO and its network providers.
• You have a right to voice grievances or appeals about iCare or the care it provides.
• You may switch HMOs without cause during the first 90 days of iCare enrollment.
• You have the right to switch HMOs, without cause, if the State imposes sanctions or temporary management on iCare.
• ​​​​​​​​​​​​​​You have the right to receive information from iCare about the organization and its services. You also have the right to receive information about any significant changes with iCare at least 30 days before the effective date of the change.​​​​​​​​
• You have the right to disenroll from the HMO program if:
• ​​​​​You move out of the HMO’s service area.
• ​​​​​​​​​​​​​​Your HMO does not, for moral or religious objections, cover a service you want.
• You need a related service performed at the same time, not all related services are available within the provider network, and your PCP or another provider determines that receiving the services separately could put you at unnecessary risk.
• ​​​​Other reasons, including poor quality of care, lack of access to services covered under the contract, or lack of access to providers experienced in dealing with your care needs.

Your Civil Rights

iCare provides covered services to all eligible members regardless of the following:

• Age
• Disability
• National Origin
• Race
• Gender
• Gender Identity
• Ancestry
• Ethnicity
• Sex assigned at birth
• Sexual orientation
• Marital status
• Religion
• Language

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 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:

• A responsibility to give iCare and our providers the information we need to provide your health care and services.
• A responsibility to follow your care plan and follow the instructions for care that you agreed to with your providers.
• A responsibility to understand your health problems.
• A responsibility to participate in creating mutually agreed-upon treatment goals to the extent you can.

 

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 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.

 

About Covered and Non-Covered Services

You do not have to pay for covered services other than required copays. 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 non-covered services. Providers may bill you up to their usual and customary charges for non-covered 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 (TTY: 711).

 

About Co-Payments

iCare and its providers and subcontractors may bill you for small service and/or prescription drug fees, called co-payments. The following members do not have to pay co-payments:

• iCare 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)
• iCare Family Care Partnership members

With your plan, you do not have to pay for covered services other than required copays. 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 non-covered services. Providers may bill you up to their usual and customary charges for non-covered 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 (TTY: 711).

 

About Medical Services Received Outside of 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 copays for emergency services provided outside Wisconsin.

iCare does not cover any services, including emergency services, provided outside the U.S., 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 U.S. 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 U.S.

If you get a bill for services, call our Customer Service Department right away at 1-800-777-4376 (TTY users dial 711).

 

If You Have 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.

 

Fraud and Abuse

If you suspect fraud or abuse of the Medicaid program, you may report it.
Please go to www.reportfraud.wisconsin.gov

 

For more information about member rights and responsibilities, plan benefits, and important phone numbers, please see the Member Handbook.

IC200 V4 DHS Approved 5/19/23
Last Updated 8/7/23