Medicare Part C Appeals

Medicare Part C Appeals


Appeal: If iCare makes a decision to deny a service or benefit you believe you are entitled to receive, you can ask iCare to reconsider 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: Independent Care makes standard appeal decisions no later than 30 calendar days from receiving the written 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 can be transferred to the standard timeframe if it is determined your life is not in serious jeopardy. Independent Care will decide whether the appeal qualifies as expedited within 2 business days. If the request for a fast appeal is denied, you will be notified in writing of your right to file an expedited grievance.

If iCare agrees that your appeal should be expedited, it will follow the same steps as a standard appeal. The appeal 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 Department
  • Attention: Member Appeals
  • Independent Care Health Plan
  • 1555 N. RiverCenter Dr. Ste. 206
  • Milwaukee, WI 53212-3958
  • Fax: 414-918-7592

What Happens Next?

  • Step 1: Within 5 business days you will receive an acknowledgment letter confirming that iCare has received your appeal
  • Step 2: Within 30 calendar days of receiving your appeal, iCare will investigate and make all reasonable efforts to gather additional information relevant to your appeal
  • Step 3: After gathering any additional information, iCare will obtain a review by a third party that was not previously involved in the decision process
  • 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 Department at 414-918-7565 or a Member Advocate at 414-231-1076.


Modified: 4/25/2019
 

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
  • All content and images unless otherwise indicated are
  • Copyright © 2019 Independent Care Health Plan