What should I do if I have a problem or complaint with my Medicare Advantage plan?
Appointment of representation
If you need help to understand or follow your coverage determination, exceptions, appeals and grievance processes, you can get assistance from a friend, lawyer or someone else. If you qualify, you can contact groups such as legal-aid services that can help you find a lawyer or give you free legal services.
If you would like to appoint a representative to assist you, please print, complete and sign the following CMS Appointment of Representative form (CMS-1696) and include it with your written request.
How to file a grievance (complaint)
The grievance or complaint process is used for certain types of problems only. This includes problems related to your quality of care, waiting times and the customer service you receive.
If you wish to file a grievance, contact us promptly – either by phone or in writing.
- Usually, calling Customer Service is the first step. If there is anything else you need to do, Customer Service will let you know. You can reach Customer Service by calling 1-877-998-0998 or TTY 711. We are open 8 a.m. to 8 p.m., 7 days a week from Oct. 1 to March 31. And 8 a.m. to 8 p.m. Monday through Friday from April 1 - Sept. 30. If you are hearing-or-speech-impaired please call TTY 711.
- If you do not wish to call (or you called and were not satisfied), you can put your complaint in writing and send it to us. If you put your complaint in writing, we will respond to your complaint in writing.
- You or someone you name may file a grievance. A family member, friend, advocate, provider or any other person may act on your behalf if you appoint them in writing to act on your behalf. Other persons may already be authorized by the court or in accordance with state law to act for you. If you want someone to act for you who is not already authorized by the court or under state law, call Customer Service and ask for the “Appointment of Representative” form. A provider may act on your behalf in the grievance procedure if the provider certifies in writing to us that you are unable to act for yourself due to illness or disability.
To file a formal grievance, you or your representative should write down your questions or concerns. We must receive the letter within 60 days of the event or incident that caused the grievance. The written grievance
should be sent to:
Security Health Plan
Attn: Quality
PO Box 8000
Marshfield, WI 54449-8000
Fax 715-221-9500
If you or your physician has questions regarding the grievance process or the status of your appeal or grievance, you may contact Customer Service at 1-877-998-0998 (TTY 711). We are open 8 a.m. to 8 p.m., 7 days a week from Oct. 1 to March 31. And 8 a.m. to 8 p.m. Monday through Friday from April 1 - Sept. 30. If you are hearing-or-speech-impaired please call TTY 711.
We must address your grievance as quickly as your case requires based on your health status, but no later than 30 days after receiving your grievance. We may extend the time frame by up to 14 days if you ask for the extension, or if we justify a need for additional information and the delay is in your best interest. If we deny your grievance in whole or in part, our written decision will explain why we denied it, and will tell you about any dispute resolution options you may have.
You can also tell Medicare about your complaint
You can submit a complaint about Security Health Plan directly to Medicare. To submit a complaint to Medicare, go to https://www.medicare.gov/MedicareComplaintForm/home.aspx. Medicare takes your complaints seriously and will use this information to help improve the quality of the Medicare program.
If you have any other feedback or concerns, or if you feel the plan is not addressing your issue, please call 1-800-MEDICARE (1-800-633-4227). TTY/TDD users can call 1-877-486-2048.
For more information, see the chapter titled “What to do if you have a problem or complaint (coverage decisions, appeals, complaints)” in your Medicare Advantage plan Evidence of Coverage.
Filing an organizational/coverage determination
- Contact us by calling, writing or faxing and request us to authorize or provide coverage for the medical care you want
- Let us know if you need a fast coverage decision, due to your health (72 hours) or standard decision (made in 14 days)
- You, your doctor or your representative can contact us
You can reach Customer Service by calling 1-877-998-0998 or TTY 711. We are open 8 a.m. to 8 p.m., 7 days a week from Oct. 1 to March 31. And 8 a.m. to 8 p.m. Monday through Friday from April 1 - Sept. 30. If you are hearing-or-speech-impaired please call TTY 711.
Security Health Plan
Attn: Health Services
PO Box 8000
Marshfield, WI 54449-8000
Fax 715-221-9500
When we give you our decision, we will use the “standard decision” deadlines unless we have agreed to use the “fast decision” deadlines. A standard coverage decision means we will give you an answer within 14 days after we receive your request.
If your health requires it, ask us to give you a “fast coverage decision.” A fast coverage decision means we will answer within 72 hours.
If we say no, you have the right to ask us to reconsider – and perhaps change – this decision by making an appeal. Making an appeal means making another try to get the medical care coverage you want.
For more information, see the chapter titled “What to do if you have a problem or complaint (coverage decisions, appeals, complaints)” in your Medicare Advantage plan Evidence of Coverage.
Process for appeals
- You, your doctor or representative must contact us either by phone or mail
- Standard appeals must be sent in writing
- If your health requires a quick response, ask for a "fast appeal" and send to us either of the two ways mentioned above
A written appeal request should be sent to:
Security Health Plan
Attn: Quality
PO Box 8000
Marshfield, WI 54449-8000
Fax 715-221-9500
To request a fast appeal, call 1-877-998-0998 or TTY 711. We are open 8 a.m. to 8 p.m., 7 days a week from Oct. 1 to March 31. And 8 a.m. to 8 p.m. Monday through Friday from April 1 - Sept. 30. If you are hearing-or-speech-impaired please call TTY 711.
When we give you our decision, we will use the “standard” deadlines unless we have agreed to use the “fast” deadlines. A standard appeal means we will give you an answer within 30 days after we receive your request.
Remember, if your health requires it, ask us to give you a “fast appeal.” A fast coverage decision means we will answer within 72 hours.
For more information, see the chapter titled “What to do if you have a problem or complaint (coverage decisions, appeals, complaints)” in your Medicare Advantage plan Evidence of Coverage.
How to obtain aggregate numbers of grievance, appeals and exceptions
To obtain the numbers of grievances, appeals and exceptions for Security Health Plan, please contact our Customer Service Department at 1-877-998-0998 (TTY 711). We are open 8 a.m. to 8 p.m., 7 days a week from Oct. 1 to March 31. And 8 a.m. to 8 p.m. Monday through Friday from April 1 - Sept. 30. If you are hearing-or-speech-impaired please call TTY 711.
Security Health Plan and its agents are not in any way connected with the Medicare program. Security Health Plan of Wisconsin, Inc., is an HMO-POS, MSA and D-SNP plan with a Medicare contract and a contract with the Wisconsin Medicaid program. Enrollment in Security Health Plan depends on contract renewal.
This information is not a complete description of benefits. Call Customer Service at 1-877-998-0998 (TTY 711) for more information.
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