Members
Grievance Policy
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. To obtain an aggregate number of grievance, appeals and exceptions filed with iCare, contact us at 1-800-777-4376.
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:
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.
Contact Us
Questions? Call us at 1-800-777-4376 (TTY 1-800-947-3529), 7 days-a-week, 8:00 a.m. to 8:00 p.m.
Medicare
PDF Resources
- Abridged Formulary/iCare Medicare Plan 2010
- Abridged Formulary/iCare Partnership 2010
- Anti-Smoking Quit Line (English)
- Anti-Smoking Quit Line (Spanish)
- BadgerCare Plus Core Member Recertification Reminder
- CMS Appointment of Representative Form
- Community Activity Facilities and Programs
- Comprehensive Formulary/iCare Medicare Plan 2010
- Comprehensive Formulary/iCare Partnership 2010
- Coverage Determination Request Form
- Emergency Room Brochure
- Enrollment Form/iCare Medicare Plan 2010
- Evidence of Coverage (EOC)/Member Handbook - 2010 iCare Partnership
- Evidence of Coverage/ANOC/iCare Medicare Plan 2010
- Fraud, Waste and Abuse Compliance Training 2010
- Greivance and Appeals Process/iCare Partnership 2010
- iCare BadgerCare Plus Program Brochure
- iCare BadgerCare Plus Program Brochure/Hmong
- iCare Medicaid SSI Program Brochure
- iCare Medicaid SSI Program Brochure/Hmong
- iCare Medicaid SSI Program Brochure/Spanish
- iCare Medicare Plan 2010 Program Brochure
- iCare Medicare Plan 2010 Program Brochure/Spanish
- iCare Road to Independence Video Challenge Package
- iCare/Independent Care Health Plan Scholarship
- Letter of Medical Necessity
- Limited English Proficiency Policy/Procedures
- LIS 2010 Premium Summary Sheet
- Medicare Part D Coverage Determination Form
- Medication Request Form - Partnership Medicaid
- Member Handbook/iCare BadgerCare Plus
- Member Handbook/iCare BadgerCare Plus Core Plan
- Member Handbook/iCare BadgerCare Plus Core Plan/Spanish
- Member Handbook/iCare BadgerCare Plus/Hmong
- Member Handbook/iCare BadgerCare Plus/Spanish
- Member Handbook/iCare Medicaid SSI
- Member Handbook/iCare Medicaid SSI/Spanish
- Notice of Formulary Change/iCare Medicare SNP 2010
- Notice of Formulary Change/iCare Partnership 2010
- Over-the-Counter Drug Program Catalog/iCare Medicare Plan 2010
- Over-the-Counter Drug Program Catalog/iCare Medicare Plan 2010/Spanish
- Over-the-Counter Drug Program Catalog/iCare Partnership Plan 2010
- Parental Consent Form
- Partnership Program Brochure/iCare 2010
- Pharmacy Directory/iCare Medicare Plan/iCare Partnership 2010
- Pharmacy Listing/iCare Medicare Plan 2010
- Pharmacy Listing/iCare Partnership 2010
- Plan Comparison brochure/iCare Partnership 2010
- Power of Attorney brochure
- Prior Authorization Criteria/iCare Medicare SNP 2010
- Prior Authorization Criteria/iCare Partnership 2010
- Privacy Statement
- Provider Directory Supplement/BadgerCare Plus
- Provider Directory/iCare BadgerCare Plus-Medicaid SSI
- Provider Directory/iCare BadgerCare Plus-Medicaid SSI/Spanish
- Provider Directory/iCare Medicare Plan 2010
- Provider Directory/iCare Partnership 2010
- Provider Manual
- Provider Newsletter Fall 2008
- Report to the Community
- Road to Independence Video Challenge Flyer
- Self-Directed Supports Brochure/iCare Partnership 2010
- Self-Directed Supports Guide/iCare Partnership 2010
- Step Therapy Prescription Drug Criteria/iCare Medicare SNP 2010
- Step Therapy Prescription Drug Criteria/iCare Partnership 2010
- Summary of Benefits/iCare Medicare Plan 2010
- Summary of Benefits/iCare Partnership 2010
- Transition Process
Call 1-800-777-4376 (TTY: 1-800-947-3529), from 8:00 a.m to 8:00 p.m.,
7 days-a-week, for further information about iCare.