Community Care Home   Community Care on Facebook  Community Care on LinkedIn   

Contact Us At:


Grievances and Appeals

Community Care is committed to providing quality service to our members, but there may be a time when you have a concern. As a member, you have the right to file a grievance or appeal a decision and to receive a prompt and fair review.

If you are unhappy with your care or services, you should discuss it with your Team first. This is usually the easiest and fastest way to address your concerns. Your Team will work with you to try to find a satisfactory solution to your problem.

If you do not want to talk with your Team, you can contact our Member Rights Specialists. The Member Rights Specialist can tell you about your rights and try to informally resolve your concerns.

Member Rights Specialist
Toll Free:
TTY: Wisconsin Relay System at 711
Calls to the numbers above are free.
Fax: 262-827-4044
Members, family members and/or representatives can call the numbers above for information on the grievance and appeal processes or for status questions.

Member Grievance and Appeal Process

You have the right to file a grievance or an appeal about your medical care, long-term care, Medicare Part D prescription drugs, over-the-counter drugs or quality of care.

If you are unable to resolve your concerns by working with your Team or a Member Rights Specialist, you have several ways to address your concerns. You can:

  • Call the Member Rights Specialist at the numbers above or write to Community Care at:

    Member Rights Specialist
    205 Bishop's Way
    Brookfield, WI 53005

    The Member Rights Specialist can help you file a grievance or appeal and will work with you throughout the entire grievance or appeal process to try to find a workable solution.

  • Ask for a review by the Wisconsin Department of Health Services (DHS).
  • Ask for a State Fair Hearing with the Wisconsin Division of Hearings and Appeals (DHA).

If you have Medicare, you can also get help and information from Medicare:

  • You can call 800-MEDICARE (800-633-4227) 24 hours a day, 7days a week. TTY users should call 877-486-2048.
  • You can visit the Medicare website at (note: clicking this link will take you to a different website).

All of the processes have been approved by Medicaid and/or Medicare. Each process has a set of rules, procedures and deadlines that must be followed by Community Care and by you to ensure that we handle grievances and appeals fairly and promptly.

To learn more about the Grievance and Appeal process, please refer to Chapter 8 in the Member Handbook & Enrollment Agreement.

Material ID: H5212_Web_12.2018 | CMS Approved: 12/19/2018

Home   |   Who We Are   |   Members & Families   |   For Providers   |   Careers   |   Consulting Services   |   Contact Us

 Corporate Headquarters: 205 Bishops Way, Brookfield, WI 53005
Phone: (414) 231-4000 Toll Free: 1-866-992-6600 TTY: Call the Wisconsin Relay System at 711
Help in Other Languages
© 2014-2019, Community Care, Inc. - All Rights Reserved   |   Privacy Policy   |   Terms of Use