Members
2012 iCare Medicare Plan
Grievance Policy
- Evidence of Coverage
- Provider/Pharmacy Directory
- Comprehensive Formulary
- Summary of Benefits
- LIS Premium Summary Sheet
- Coverage Determination Request Form
- Redetermination Request Form
- CMS Appointment of Representative form
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, Chapter 9, Section 11 if you have a complaint (grievance), 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.
Last Updated: 12/09/2011
Medicare
PDF Resources
Listing of CMS approved iCare Medicare publications, Medicaid publications, third-party preventive health brochures.
- Abridged Formulary/iCare Medicare Plan 2012
- Abridged Formulary/iCare Partnership 2012
- Annual Notice of Change (ANOC)/iCare Medicare Plan 2012
- Annual Notice of Change (ANOC)/iCare Partnership 2012
- Anti-Smoking Quit Line (English)
- Anti-Smoking Quit Line (Spanish)
- Caregiver Background Check Policy
- Claim Form LTC Professional Services - Trizetto
- Claim Form LTC Residential Services - Trizetto
- CMS Appointment of Representative Form
- Comprehensive Formulary/iCare Medicare Plan 2012
- Comprehensive Formulary/iCare Partnership 2012
- Emergency Room Brochure
- Enrollment Form/iCare Medicare Plan 2012
- Evidence of Coverage/iCare Medicare Plan 2012
- Evidence of Coverage/iCare Partnership 2012
- Family Care Partnership Provider Application
- FCP Provider Reference Manual
- First Tier, Downstream and Related Entities Fraud
- Formulary Change Notice (iCare Medicare Plan)
- Formulary Change Notice (iCare Partnership)
- HCFA Claim Required Fields
- Limited English Proficiency Policy/Procedures
- LIS Premium Summary Sheet 2012
- Member Handbook/BadgerCare Plus Core Plan
- Member Handbook/iCare Medicaid SSI
- Member Recertification Reminder/BadgerCare Plus Core
- Notice of Privacy Practices
- Part D Coverage Determination Request Form
- Part D Prior Authorization Criteria/iCare Medicare Plan 2012
- Part D Prior Authorization Criteria/iCare Partnership 2012
- Part D Redetermination Request Form
- Pharmacy Listing/iCare Medicare Plan 2012
- Pharmacy Listing/iCare Partnership 2012
- Plan Comparisons/iCare Partnership 2012
- Power of Attorney brochure
- Primary & Acute Care Information Form
- Prior Authorization List 4/19/12
- Prior Authorization List 4/19/12 pdf
- Program Brochure/Hmong/iCare Medicaid SSI
- Program Brochure/iCare BadgerCare Plus
- Program Brochure/iCare Medicaid SSI
- Program Brochure/iCare Partnership
- Program Brochure/Spanish/iCare Medicaid SSI
- Program Overview (Spanish)/iCare Medicaid SSI
- Program Overview (Spanish)/iCare Partnership
- Provider Directory/iCare Medicaid SSI-BadgerCare Plus_Expansion Counties
- Provider Directory/iCare Medicaid SSI-BadgerCare Plus_Original Counties
- Provider Directory/Pharmacy Directory/iCare Medicare Plan Expansion Counties 2012
- Provider Directory/Pharmacy Directory/iCare Medicare Plan Original Counties 2012
- Provider Information Form (other than Partnership Program)
- Provider Reference Manual 2012
- Provider/Pharmacy Directory - iCare Partnership 2012
- Recertification Reminder (flyer)/BadgerCare Plus
- Self-Directed Supports Program Overview/iCare Partnership
- Step Therapy Prescription Drug Criteria/iCare Medicare Plan 2012
- Step Therapy Prescription Drug Criteria/iCare Partnership 2012
- Summary of Benefits/iCare Medicare Plan 2012
- Summary of Benefits/iCare Partnership 2012
- Transition Process
- UB Claim Required Fields
- Value to the Family
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.
