Filing a Grievance About Your Prescription Drug Coverage

What is a grievance?

A grievance is any complaint other than one that involves a coverage determination. You may file a grievance if you have any type of problem with the iCare Medicare Plan or one of our network pharmacies that does not relate to coverage or a payment decision for a prescription drug.

What types of problems might lead to you filing a grievance?

• You feel that you are being encouraged to leave (disenroll from) the iCare Medicare Plan.

• Problems with the member service you receive.

• Problems with how long you have to spend waiting on the phone or in the pharmacy.

• Disrespectful or rude behavior by pharmacists or other staff.

• Cleanliness or condition of pharmacy.

• If you disagree with our decision not to expedite your request for an expedited coverage determination or redetermination.

• You believe our notices and other written materials are difficult to understand.

• Failure to give you a decision within the required timeframe.

• Failure to forward your case to the independent review entity if we do not give you a decision within the required timeframe.

• Failure by the Plan to provide required notices.

• Failure to provide required notices that comply with CMS standards.

How to file a grievance

If you have a grievance, we encourage you to first call Member Services at 1-800-777-4376 (TTY 1-800-947-3529), 7 days-a-week, 8:00 a.m. to 8:00 p.m.  We will try to resolve any complaint that you might have over the phone. If you request a written response to your phone complaint, we will respond in writing to you. If we cannot resolve your complaint over the phone, write us at:

Independent Care Health Plan
Attn: Member Advocate
1555 N. RiverCenter Dr. Suite 202 A
Milwaukee, WI 53212

We cannot treat you in a different way because you file a complaint. Your health care benefits will not be affected. We will provide all non-English speaking and hearing-impaired members with interpreter services during the grievance process.

We 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. We may extend the timeframe by up to 14 calendar days if you request the extension, or if we justify a need for additional information and the delay is in your best interest.

If you would like to inquire about the status of a grievance, please call Member Services at 1-800-777-4376 (TTY 1-800-947-3529), 7 days-a-week, 8:00 a.m. to 8:00 p.m.

See your Evidence of Coverage, Section 11, "Appeals and Grievances: What To Do If You Have Complaints About Your Part D Prescription Drug Benefits," for more information.