Member Advocacy
 Advocacy, Complaints and Appeals
 State of Wisconsin Ombuds Program
The State has Ombuds who can help you with any questions or problems. Ombuds
can tell you how to get coverage from
iCare. Ombuds also can help you solve
problems or complaints you may have about
iCare. Call 1-800-760-0001 to
speak to an Ombud.
Complaints or Grievances
If you have a complaint or grievance about the
iCare program, please call
iCare’s
Member Advocate at 414-223-4847 or write us at:
Independent Care Health Plan
Attn: Member Advocate
1555 N. RiverCenter Dr. Suite 202 A
Milwaukee, WI 53212
If you want to talk to someone outside of
iCare about the problem, call
the state’s enrollment specialist at 1-800-291-2002. The enrollment
specialist may be able to help you, or can help you write a formal complaint
to iCare or to the Wisconsin Managed Care program.
To file a grievance with the Wisconsin Managed Care program contact:
MCO Ombuds
P. O. Box 6470
Madison, WI 53716
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.
If you believe
you have been discriminated against in any way that relates to applying for
Wisconsin Medicaid or receiving Medicaid services, contact:
Affirmative Action/Civil Rights
Compliance Officer
Department of Health and Family Services
PO Box 7850
Madison WI 53707-7850
1-608-266-3465
1-608-266-3356 (voice)
1-608-266-2555 (TTY)
- or -
You may also register
complaints at the federal level with:
U.S. Department of Health and
Human Services
Office of Civil Rights — Region V
233 N Michigan Ave, Ste 240
Chicago IL 60601
1-312-886-2359 (voice)
1-312-353-5693 (TTY)
When benefits are denied (fair hearings)
You have a right to appeal to the state Division of Hearings and Appeals (DHA)
for a fair hearing if you believe your benefits are unfairly denied,
limited, reduced, delayed or stopped by
iCare. An appeal must be made no
later than 45 days after the date of the letter you and your doctor receive
from iCare. If you appeal this action to the DHA before the effective date,
the service may continue. You may have to pay for the cost of services if
the hearing decision is not in your favor.
For a fair hearing, send a written request to:
Department of Administration
Division of Hearings and Appeals
Box 7875
Madison, WI 53707-7875
The hearing will be held in Milwaukee County. You have a right to bring a
friend or be represented by someone at the hearing. If you need a special
arrangement for a disability, or for English language translation, please
call 608-266-3096 (voice) or 608-264-9853 (hearing impaired).
Remember, we cannot treat you differently than other members because you
request a Fair Hearing. Your health care benefits will not be affected. If
you need help writing a request for a Fair Hearing, please call:
MCO Ombuds
1-800-760-0001 - or -
MCO Enrollment Specialist
1-800-291-2002
Advice, Records & Advanced Directives
Second Medical Opinion
A second medical opinion on recommended surgeries may be a good idea
in some cases. Remember, you have a right to ask for a second
opinion. You also can ask your care coordinator for help with your
decision.
Right to Medical Records
You have the right to ask for copies of your medical records, that
we may have. Please
call your Care Coordinator if you need help. Please note: You may have to
pay to copy your records. You also can correct wrong information in
your records if your doctor agrees.
Advanced Directives
You have a right to make decisions about your medical care. You have
a right to accept or refuse medical or surgical treatment. You also
have the right to plan and direct the types of health care you may
receive in the future if you become unable to express your wishes.
You can let your doctor know about your feelings by completing a
living will or power of attorney for health care form. Contact your
doctor for more information.
 Billing
Questions
When you may be billed for
services
It is very important 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, hospitals and pharmacies unless you have our
approval. The only exception is for severe emergencies.
If you are billed
If you receive a bill for services, call our Claims Department at
414-223-4847. You do not have to pay for services that are
covered by
iCare.
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 Enrollment
Specialist at 1-800-291-2002. The Enrollment Specialist can tell you
how to match your Managed Care Organization with your other
insurance so you can use both insurance plans.
Provider Payment and Credentials
How
We Pay Our Providers
You are entitled 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 Provider
Relations Department at 414-223-4847 and request information about
our physician payment arrangements.
Provider Credentials
You have the right to information about the providers in our network that includes
the provider's education, board certification and recertification. To get
this information, call our Provider Relations Department. |
