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MetaStar is authorized by the Department of Health Services (DHS) to review all appeals and grievances that are submitted to DHS by or on behalf of members or participants enrolled in the following programs:
Acting on behalf of DHS, MetaStar reviews members’ or participants’ appeals and grievances related to each program’s covered benefits as well as appeals concerning eligibility and enrollment matters.
In addition, MetaStar concurrently reviews issues related to members’ or participants’ requests for state Fair Hearings that have been accepted by the Wisconsin Division of Hearings and Appeals.
MetaStar offers members information about resources and options available to address their concerns and informs them about the availability of ombudsman (advocacy) services.
The appeal and grievance process conducted by MetaStar involves mediation and negotiation, with the goal of informal resolution. The process DOES NOT result in a formal decision. For more information on Family Care appeals and grievances, please visit the DHS website.