Part C Grievance Policy

Medicare Part C Complaints and Grievances


What is a Grievance?

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

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

Independent Care treats every complaint as a grievance. This means that iCare 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.

How to File a Grievance

If you have a grievance, you are encouraged to call Customer Service at 1-800-777-4376 (TTY 1-800-947-3529). Independent Care will try to resolve any complaint that you might have over the phone. Independent Care will notify you in writing within 10 business days that your grievance has been received. If iCare 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
  • Attention: Member Grievances
  • 1555 N. RiverCenter Dr., Suite 206
  • Milwaukee, WI 53212
  • OR
  • Fax: 414-918-7592

If you want a fast (expedited) decision about your grievance, you must ask for it in writing. Independent Care will resolve expedited grievances within 3 business days. If Independent Care decide that your condition does not require a fast (expedited) decision, Independent Care 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.

Independent Care 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. Independent Care may extend the timeframe by up to 14 calendar days if you request the extension, or if iCare is able to justify a need for additional information and the delay is in your best interest.

Independent Care cannot treat you in a different way because you file a complaint. Your health care benefits will not be affected. Independent Care 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: 6/7/2019
 

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