You have the right to voice a complaint or file a grievance regarding any dissatisfaction you experience with our health plan. We will provide you with a prompt and fair review of your concern. In order to learn more about your specific grievance procedure, please contact Customer Service.

 
Independent Review Rights

To determine if your plan has independent review rights available, please contact our Member Advocate at (608) 775-8052 or (800) 897-1923, extension 58052.

Wisconsin Residents
In addition to your right to file a complaint or grievance concerning your claim or benefit denial, you may also be entitled to an independent review by medical professionals who have no connection to Gundersen Lutheran Health Plan to address your concerns. Typically, you must first complete Gundersen Lutheran Health Plan’s internal grievance process before you can initiate an independent review. However, you do not need to complete the grievance process if you need immediate medical treatment and the time period for completing the grievance process will cause a delay that could jeopardize your life or health or we agree with you that it is in everyone's best interest to proceed with your concern directly to independent review.

Please refer to Section 7 of your Certificate of Coverage for more information on your independent review rights. The section contains valuable information regarding the independent review process. You can also access the Fact Sheet on the Independent Review Process in Wisconsin here and a listing of certified independent review organizations here. Additional information regarding eligibility for an independent review may be obtained from the Office of the Commissioner of Insurance (OCI) at 608-266-0103 (Madison) or (800) 236-8517 (outside Madison), or OCI's Web site at: http://oci.wi.gov/bulletin/0402iro.htm

If you have questions on how to request an independent review, contact our Member Advocate at (608) 775-8052 or (800) 897-1923, extension 58052.  The Member Advocate will be able to answer your questions and to provide you with a list of certified IROs and the procedures to follow.

Iowa Residents
In addition to your right to file a complaint or grievance concerning your claim or benefit denial, you may also be entitled to an independent, external review by medical professionals who have no connection to Gundersen Lutheran Health Plan to address your concerns. You must first exhaust Gundersen Lutheran Health Plan’s internal grievance process before you can initiate an independent, external review. For Iowa residents, an independent, external review of the appeal will first be re-evaluated through the Iowa Insurance Division.

Please refer to Section 7 of your Certificate of Coverage for more information on your independent review rights. This section contains valuable information regarding the independent review process. Additional information regarding your external review eligibility may also be obtained from the Iowa Insurance Division at (515) 282-4227 or if you have questions on how to request an independent, external review, contact our Member Advocate at (608) 775-8052 or toll-free at (800) 897-1923, extension 58052. 

A member or authorized representative may also obtain a complaint form by calling the Iowa Insurance Division at (515) 281-6348 or toll-free at (877) 955-1212 from 8:00 a.m. to 4:30 p.m. Monday through Friday or via email at iid.marketregulation@iid.state.ia.us or by submitting a complaint online at: www.iid.state.ia.us/about_us/consumer/complaints/online.asp?linksback