Grievance and Appeals

Understanding grievances and appeals:

At Lakeland Care, we are committed to providing quality services to all members! There may be a time when you have a concern. As a member of Lakeland Care, you have the right to file a grievance or appeal a decision that was made.

If you are unhappy with your care or services, you should talk with your care team first. This is usually the easiest and fastest way to address your concerns. If you don’t want to talk with your care team, you can call Lakeland Care’s Member Rights Specialist. The Member Rights Specialist can tell you about your rights and try to informally resolve your concerns.

Member Rights Specialist – Toll Free: 1-877-227-3335

If you are unable to resolve your concern by working with your care team or the Member Rights Specialist, you have several other ways to address your concerns. You can:

• File a grievance or appeal with Lakeland.
• 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).

Each of these options have different rules, procedures and deadlines.

What is a grievance: A grievance is when you are not satisfied with Lakeland Care, one of our providers, or have concerns about the quality of your care or services. You can file a grievance at any time. You, your legal representative, or someone on your behalf with written permission, can file a grievance. An example of a grievance may be: You feel your care team doesn’t listen to you, or your personal care worker arrives late.

What is an appeal: An appeal is a request for a review of a decision made by Lakeland Care. For example, you can file an appeal if your care team denies a service or support that you requested. Other examples include decisions to reduce or end a service or support, limit a request for a service or support, or deny payment of a service or support. You, your legal representative, or someone on your behalf with written permission, can file an appeal.

Chapter 8 of the Lakeland Care Member Handbook can help you understand each of these options and outlines the process you can follow.

The Member Rights Specialist is available to help you file a grievance or appeal. There are also Ombudsman programs available to help all Family Care members with grievances and appeals. You can find their contact information in the Lakeland Care Member Handbook as well.

You will not get into trouble or have your care be impacted if you disagree with your care team. If you file a grievance or appeal with Lakeland, our providers, or the State of Wisconsin, you will not be treated differently. We want you to be satisfied with your care!