Part C Grievance Policy

Medicare Part C Complaints and Grievance Policy


What is a Grievance?

A grievance is any expression of dissatisfaction by a member or member’s authorized representative about:

  • iCare services or procedures
  • a contracted provider’s services or procedures
  • services arranged by iCare or a contracted provider

iCare treats every complaint as a grievance. This means that we will keep track of member complaints, take your concerns seriously and make sincere efforts to resolve them.

Dissatisfaction with a determination of coverage is not considered a grievance, but may be treated as an appeal. It is iCare’s responsibility to determine whether your complaint is a grievance or an appeal, or has pieces of both.

What types of problems might lead to you filing a grievance?

  • You feel that you are being encouraged to leave (disenroll from) one of our Medicare plans
  • 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 iCare or a provider’s staff
  • Cleanliness or condition of an office or facility
  • 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
  • iCare does not notify you of a decision within the required time frame
  • iCare does not give you proper notice of your rights and/or responsibilities
  • iCare’s notices do not comply with the Center for Medicare Services standards
  • Delays in service or delivery of DME by a contracted provider

How to File a Grievance

If you have a grievance, we encourage you to first call Customer Service at 1-800-777-4376 (TTY 1-800-947-3529). We will try to resolve any complaint that you might have over the phone. We will notify you in writing within 10 business days that your grievance has been received. If we cannot resolve your complaint over the phone, the Quality Improvement department will conduct an investigation. At the conclusion of the investigation, you will receive a letter explaining how iCare resolved your grievance.

If you want your grievance to be in writing (this is not required for standard grievances), please send it to:

  • Independent Care Health Plan
  • 1555 N. RiverCenter Dr., Suite 206
  • Milwaukee, WI 53212
  • OR
  • Fax: 414-231-1092

If you want a fast (expedited) decision about your grievance, you must ask for it in writing. We will resolve expedited grievances within 3 business days. If we decide that your condition does not require a fast (expedited) decision, we will notify you in writing that it has been transferred to the standard time frame. You have the right to appeal a determination that iCare makes denying a fast (expedited) decision.

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.

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 would like to inquire about the status of a grievance, please call Customer Service at 1-800-777-4376 (TTY 1-800-947-3529).

Ombudsman

The Medicare Ombudsman is also available to assist you with complains, grievances, and information requests.

You can also contact iCare’s Member Advocate/Member Rights Specialist at 414-231-1076 for assistance.


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
  • All content and images unless otherwise indicated are
  • Copyright © 2018 Independent Care Health Plan