Filing a Grievance 

If your health care is being stopped, reduced or denied by your HMO or if you have other problems with your HMO, there are several ways you can get help. Remember that you do not have to follow all these steps in order to get your problem resolved. 

What is a grievance? 

A grievance is an oral or written

complaint to your HMO. 
 

The HMO must get back to you about your complaint within 10 days. In an urgent case, the HMO must get back to you within four days or sooner.

 

You have the right to a face-to-face meeting with the HMO person looking into your complaint and to provide any papers, such as medical records or letters from your doctor, in order to support your complaint.

 

You can be represented by a friend or an advocate in a grievance hearing.

STEPS: 
 

Talk to your clinic staff, doctor, nurse or the customer service department of your HMO.   If step 1 fails or if you have an urgent problem, speak to the HMO advocate who has been appointed by the HMO to help you. See HMO ADVOCATES   If step 1 or 2 does not resolve your problem, you can file a grievance with your HMO.

or 

You can file a fair hearing with the state at any time. 
If you file a state fair hearing within 10 days of receiving a notice that your medical care will be reduced or terminated, the HMO cannot reduce or terminate your benefits until a fair hearing decision is issued.  See REQUESTING A FAIR HEARING . 

Note: You will not get services continued, if you only request a grievance from the HMO. 

If you need help: contact the Ombuds Program at 1-800-760-0001 or the Health Advocacy Project at Legal Action of Wisconsin or Community Advocates. 
See  HEALTH ADVOCACY PROJECT .