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Member Information -
Filing an Appeal with Your MCO

If you received a notice of action for a termination, denial or reduction of services and you disagree with this decision you can appeal. You have the right to appeal to your MCO's Grievance and Appeals Committee. You can appear in person, if you choose. You can bring an advocate, friend, family member or witness. You may also present evidence to this committee.

It is your right to file an appeal but you could also contact your Care Manager or the Member Rights Specialist to informally resolve the concern. Informal resolution is typically quicker and more beneficial for you.

To file an appeal with the MCO's Grievance and Appeals Committee, contact your Care Manager or the Member Rights Specialist. You can also start the process by submitting a request form. Please select the request form for the your MCO.  

Managed Care Organization (MCO) Link to Form
Care Wisconsin Form F-02037 Care Wisconsin
Community Care Connections of Wisconsin Form F-00237 CCCW
Community Care, Inc. Form F-00237 CCI
Form F-00237S_CCI (Spanish)
ContinuUs (formerly Southwest Family Care Alliance) Form F-00237 ContinuUs
Independent Care Health Plan Form F-00237 iCare
Lakeland Care District Form F-00237 LCD
Milwaukee County Department of Family Care Form F-00237 Milwaukee
Western Wisconsin Cares Form F-00237 WWC

Note: the forms are MS Word fillable. Microsoft Word - Fillable forms, can be filled in, saved, and transmitted electronically.  You must have access to Microsoft Office 97, or a more recent version, to use these forms.

Last Revised: August 04, 2014