Contact your local Equal Employment Opportunity (EEOC)
office by phone 1-800-669-4000 or 1-800-669-6820 (TTY). You can also file a
charge by mail by sending a letter including the following information:
Your name, address, and
The name, address and
telephone number of the employer (or employment agency or union) you want
to file your charge against
The number of employees
employed there (if known)
A short description of the
events you believe were discriminatory (for example, you were fired,
When the events took place
Why you believe you were
discriminated against (for example, because of your race, color, religion,
sex (including pregnancy), national origin, age (40 or older), disability
or genetic information)
can be sent to:
Reuss Federal Plaza
310 West Wisconsin Avenue, Suite
Milwaukee, WI 53203-2292
Title III (Discrimination
based on disability in public accommodations)
Send a letter to the Department of Justice and include the
full name, address, and telephone number, and the name of the party
- The name of the business, organization, or institution that you believe has
- A description of the act or acts of discrimination, the date or dates of the
discriminatory acts, and the name or names of the individuals who you believe
- Other information that you believe necessary to support your complaint.
Please send copies of relevant documents. Do not send original
documents. (Retain them.)
Sign and send the letter to the following address:
Department of Justice
950 Pennsylvania Avenue, NW
Civil Rights Division
Disability Rights - NYAVE
Washington, D.C. 20530
For complaints about telecommunications relay services (TRS)
Jack R. Cassell
WI TRS Contract Administrator
Wisconsin Department of Administration
101 East Wilson Street, 8th Floor
Madison, WI 53707-7844
Phone (TTY) 608-267-6934; FAX 608-266-2164
Videophone Number: 608-234-4781
TRS Provider: Sprint Relay
Medicare Appeals Process
How you file an appeal depends on
the type of Medicare coverage you have. If you have Original
If you want to file an appeal, get the Medicare Summary Notice (MSN)
that shows the item or service you’re appealing. You must file the appeal
within 120 days of the date you get the MSN.
You can file your appeal in one of
1. Follow the instructions on the back of the MSN.
2. Fill out the Redetermination Request Form,
and send it to the Medicare contractor at the address listed on the MSN.
You will generally get a decision
from the Medicare contractor (either in a letter or a Medicare Summary Notice)
within 60 days after they get your request.
If you have a Medicare
Prescription Drug Plan, you have the right to do all of the following
(even before you buy a certain drug):
written explanation (called a “coverage determination”) from your Medicare
drug plan. A coverage determination is the first decision made by your
Medicare drug plan (not the pharmacy) about your benefits, including
whether a certain drug is covered, whether you’ve met the requirements to
get a requested drug, how much you pay for a drug, and whether to make an
exception to a plan rule when you request it.
for an exception if you or your prescriber (your doctor or other health
care provider who is legally allowed to write prescriptions) believes you
need a drug that isn’t on your plan’s formulary.
for an exception if you or your prescriber believes that a coverage rule
(such as prior authorization) should be waived.
for an exception if you think you should pay less for a higher tier (more
expensive) drug because you or your prescriber believes you can’t take any
of the lower tier (less expensive) drugs for the same condition.
You or your prescriber must contact
your plan to ask for a coverage determination or an exception. If your network
pharmacy can’t fill a prescription, the pharmacist will show you a notice that
explains how to contact your Medicare drug plan so you can make your request.
If the pharmacist doesn’t show you this notice, ask to see it.
You or your prescriber may make a
standard request by phone or in writing, if you’re asking for prescription drug
benefits you haven’t received yet. If you’re asking to get paid back for
prescription drugs you already bought, you or your prescriber must make the
standard request in writing.
You or your prescriber can call or
write your plan for an expedited (fast) request. Your request will be expedited
if you haven’t received the prescription and your plan determines, or your
prescriber tells your plan, that your life or health may be at risk by waiting.
If you’re requesting an exception,
your prescriber must provide a statement explaining the medical reason why the
exception should be approved.