Medicare Part C Appeals

Medicare Part C Appeals


Appeal: If we make a decision to deny a service or benefit you believe you are entitled to receive you can ask us to rereview the decision. You have 60 calendar days from the date of the denial letter to submit a written request for an appeal.

Two Types of Appeals:

Standard: Standard appeal decisions are made no later than 30 calendar days from receiving the request for an appeal. Independent Care may extend the timeframe up to 14 calendar days if you request the extension or if iCare is able to justify that an extension is in your best interest.

Expedited (fast) Appeal: You can ask for an expedited appeal if you feel your health could be in jeopardy by waiting the standard timeframe. Expedited appeals are decided within two business days. Expedited appeals can be transferred to the standard timeframe if it is determined your life is not in serious jeopardy.

Expedited appeals follow the same steps as a standard appeal, however the process will be completed within 72 hours from receiving the appeal request.

Standard appeals must be submitted within 60 calendar days from the date on the denial notice by writing to:

  • Quality Improvement Specialist
  • Independent Care Health Plan
  • 1555 N. RiverCenter Dr. Ste. 206
  • Milwaukee, WI 53212-3958

What Happens Next?

  • Step 1: Within 5 business days you will receive an acknowledgment letter confirming your appeal has been received
  • Step 2: Within 30 business days of receiving your appeal iCare will investigate and make all reasonable efforts to gather additional information relevant to your appeal
  • Step 3: A copy of the appeal file is sent to a third party who was not previously involved in the decision making process for review
  • Step 4: If the third party review determines iCare made an incorrect decision, iCare will authorize the service in dispute
  • Step 5: If the third party review determines iCare made the correct decision, the appeal file is forwarded to an independent reviewer hired by Medicare to make a final decision
  • You will receive written notification of the final decision

If you need assistance filing an appeal, contact iCare’s Quality Improvement Specialist at 414-225-4733 or a Member Advocate at 414-231-1076.


Modified: 10/2/2018
 

Independent Care Health Plan (iCare) is a Medicare Advantage (HMO SNP) organization with a Medicare contract and a contract with the State Medicaid program. Enrollment in plans insured by iCare depends on contract renewal. Plans insured by iCare are available to anyone who has both Medical Assistance from the State and Medicare. For more information about long-term care options available to you, contact your local Aging and Disability Resource Center (ADRC). The ADRC can also assist you with information about eligibility and enrollment. This information is not a complete description of benefits. Call 1-800-777-4376 (TTY:1-800-947-3529) for more information. Independent Care Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-777-4376 (TTY: 1-800-947-3529). LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-800-777-4376 (TTY: 1-800-947-3529).

  • H2237_IC2029
 
  • Independent Care Health Plan
  • 1555 RiverCenter Drive, Suite 206
  • Milwaukee, WI 53212
  • Customer Service: 1-800-777-4376
    • 24 hours-a-day, 7 days-a-week
    • (Office Hours: Monday-Friday, 8:30 a.m. to 5:00 p.m.)
  • TTY: 1-800-947-3529
  • Fax: 414-231-1092
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