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The state and federal government administers medical assistance (Medicaid) coverage for certain low-income populations who cannot afford private health insurance coverage due to income level or other circumstances. To see if you qualify, visit healthcare.gov or complete an on-line application at access.wisconsin.gov.

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ENROLLMENT INFORMATION

 If you have questions about enrollment, you can reach an enrollment specialist at (800) 291-2002. 

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FORWARD HEALTH ID CARD

If you need a new ForwardHealth Identification (ID) card, call the Department of Health Services at (800) 291-2002.

BADGERCARE PLUS

Gundersen Health Plan is a BadgerCare Plus Health Maintenance Organization (HMO) option. To learn more, please refer to the Gundersen Health Plan 2014/2015 Member Handbook.

Pharmacy, Chiropractic and Dental coverage for BadgerCare Plus members is provided by the State of Wisconsin. These services are not covered by Gundersen Health Plan. You can choose to receive these services from any Wisconsin provider that will accept your ForwardHealth ID Card.

Do you have questions?
If you need our help understanding your insurance coverage, please contact us. Our customer service representatives are available to meet with you in person at our Onalaska office or our Gundersen Health Resource Center office (located in Gundersen's 1836 South Avenue office in La Crosse). Member materials can be provided in another language upon request. They can also be provided as an audio recording for our visually impaired members. If you have any special needs, please let us know how we can better serve you.

Additional Health Resources
Do you have a health related question? The Telephone Nurse Advisor Line is available to you 24 hours a day, 7 days a week at (608) 775-4454 or (800) 858-1050. This service is provided by Gundersen Health System. It’s free and confidential.

Complaints, Grievances and Appeals
If you have a complaint about your care or the service you receive from Gundersen Health Plan or any of our doctors, clinics or hospitals, please call our Customer Service Department at (866) 537-1477 or (608) 775-0150. You can also send a complaint to us in writing at: 

Gundersen Health Plan 
Attention - Customer Service 
Mailstop NCA2-01 
1900 South Avenue  
La Crosse, WI 54601 

If we do not resolve your problem, you have the right to file a formal written grievance or appeal to Gundersen Health Plan’s member advocate at: 

Gundersen Health Plan 
Attention - Member Advocate 
Mailstop NCA2-01 
1900 South Avenue 
La Crosse, WI 54601 

If you want to talk to someone outside of Gundersen Health Plan about the problem, you can call the HMO enrollment specialist at (800) 291-2002. The enrollment specialist may be able to help you solve the problem, or can help you file a formal grievance to the BadgerCare Plus program. The address to complain to the Wisconsin BadgerCare Plus program is: 

BadgerCare Plus Managed Care Ombuds 
P.O. Box 6470 
Madison, WI 53716-0470 
Phone: (800) 760-0001 

If your complaint, grievance or appeal needs action right away because a delay in treatment would greatly increase the risk to your health, please call Gundersen Health Plan as soon as possible. We will require verification from your doctor that a delay in treatment is a health risk.

You have the right to appeal to the State of Wisconsin Division of Hearings and Appeals (DHA) for a fair hearing if you believe that your benefits are wrongly denied, limited, reduced, delayed or stopped by Gundersen Health Plan. An appeal must be made no later than 45 days after the date of the action being appealed. If you appeal an action to DHA before the effective date, the service may continue. You may need to pay for the cost of the services if the hearing decision is not in your favor. You may file an appeal to DHA at any time, even if you have already filed an appeal with Gundersen Health Plan. 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 (voice) or (608) 264-9853 (hearing impaired). If you need help writing a request for a fair hearing, please call either the BadgerCare Plus Ombudsman at (800) 760-0001 or the HMO Enrollment Specialist at (800) 291-2002.

Gundersen Health Plan cannot treat you differently than other members because you file a complaint, grievance, appeal or request a fair hearing. Your healthcare benefits will not be affected. 

Privacy
Please refer to the Member Handbook for information regarding privacy.