Dean Health Plan BadgerCare Plus Member Handbook - page 14

State of Wisconsin
HMO Ombuds
The state has an Ombuds who
can help you with any questions
or problems you have as an HMO
member. The Ombuds can tell
you how to get the care you need
from your HMO. The Ombuds can
also help you solve problems or
complaints you may have about the
HMO program or your HMO. Call
(800) 760-0001 and ask to speak to
an Ombuds.
Complaints, Grievances
and Appeals
We would like to know if you have
a complaint about your care at DHP.
Please call DHP’s Customer Care
Center at (800) 279-1301 if you have
a complaint. Or you can write to us
at:
Dean Health Plan
Attn: Grievance/Complaint Analyst
P.O. Box 56099
Madison, WI 53705
If you want to talk to someone
outside of Dean Health Plan about
the problem, call an HMO Enrollment
Specialist at (800) 291-2002. An
Enrollment Specialist may be able to
help you solve the problem or help
you write a formal grievance to DHP
or to the Wisconsin BadgerCare Plus
Program. Submit your complaint
to the Wisconsin BadgerCare Plus
Program at:
Wisconsin BadgerCare Plus
Managed Care Ombuds
P. O. Box 6470
Madison, WI 53716-0470
(800) 760-0001
If your complaint or grievance
needs action right away because
a delay in treatment would greatly
increase the risk to your health,
please call DHP as soon as possible
at (800) 279-1301. We cannot treat
you differently than other members
because you file a complaint or
grievance. Your health care benefits
will not be affected.
Fair Hearings
(When Benefits are Denied)
You have the right to appeal to
the State of Wisconsin Division of
Hearings and Appeals (DHA) for
a Fair Hearing if you believe your
benefits are wrongly denied, limited,
reduced, delayed or stopped by
DHP. An appeal must be made no
later than 45 days after the date of
the action being appealed. If you
appeal this action to DHA before
the effective date, the service may
continue. You may need to pay for
the cost of services if the hearing
decision is not in your favor.
If you want a Fair Hearing, send
a written request to:
Department of Administration
Division of Hearings and Appeals
P. O. Box 7875
Madison, WI 53707-7875
The hearing will be held in the county
where you live. You have the right
to bring a friend or be represented
at the hearing. If you need a special
arrangement for a disability or for
English language translation, please
call (608) 266-3096 or
(608) 264-9853 for hearing impaired.
We cannot treat you differently
than other members because you
request a Fair Hearing. Your health
care benefits will not be affected. If
you need help writing a request for
a Fair Hearing, please call:
Wisconsin Managed Care Ombuds
at (800) 760-0001 or
HMO Enrollment Specialist
at (800) 291-2002
deancare.com
BadgerCare Plus Member Handbook
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