June 6, 2020

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Need a Ride? Non-Emergency Medical Transportation

If you have a car and are able to drive yourself to your appointment but...

If you have a car and are able to drive yourself to your appointment but cannot afford to pay for gas, you could get money for gas. The amount of money you get depends on how many miles you drive to get to your appointment. The reimbursement rate is 24 cents a mile.

  1. Before your appointment, call MTM, Inc. at 1-866-907-1493. Ask for trip logs to be mailed to you.
  2. Fill out the trip log with the following information:
  • Your trip number (get this from MTM, Inc.) Medicaid & BadgerCare Plus Mileage Reimbursement Trip Log Image
  • Appointment date
  • Appointment time
  • Type of trip (round trip or one-way)
  • Starting address
  • Health care provider’s phone number
  • Health care provider’s name
  • Health care provider’s address
  1. At your appointment, ask a doctor, nurse, or front desk staff to sign the trip log.
  2. Within 60 days, send the completed log to:
  • MTM, Inc., Attention: Trip Logs
    16 Hawk Ridge Drive
    Lake St. Louis, MO 63367
  • Fax: 1-888-513-1610
  1. MTM, Inc. will mail you a debit card with money on it and a letter that will tell you how to activate your card. Keep this card as it will be reloaded with money from future trips.
  • Gas money can be paid to you or another driver.
  • You can get gas money for trips to your children’s appointments.
  • You can include a trip to the pharmacy on your trip log.
  • All trips must be verified to get money for gas.
  • Any money you get for gas is put onto your debit card every Wednesday.

If you don’t get the trip log in time for your appointment:

  • Print the trip log from the MTM, Inc. website.
  • Get a note from your provider that has a signature, and send that note with the trip log when you send it to MTM, Inc..

Anyone, including health care providers, can file a complaint with MTM, Inc. about ride services. Complaints may be about issues such as having a hard time getting a ride, long wait times, or drivers who are late. You can file a complaint by:

  • Calling 1-866-436-0457
  • Writing to:
    MTM, Inc. Quality Management
    5117 W. Terrace Dr., Ste 400
    Madison, WI 53708
  • Going online

When filing a complaint, you must have your ForwardHealth ID number, name, and date of service or trip number.

After receiving your complaint, MTM, Inc. will mail you a response within 10 business days. If your complaint is not resolved within 10 business days, MTM, Inc. will mail you a final response within 30 business days of receiving your complaint. You can request an appeal of a MTM, Inc. decision.

If you are unhappy with how your complaint was resolved, there is further complaint information in the letter MTM, Inc. sends you.

If you were denied a transportation service by MTM, Inc. and you do not think it should have been denied, you have the right to appeal. Denials may include a denied ride or denied payment for mileage.

To appeal a denied transportation service, you can either appeal to the MTM, Inc. ombudsman or request a fair hearing directly from the Division of Hearings and Appeals.

Appealing to the MTM, Inc. ombudsman is optional but may be the fastest way to resolve your denial because you may be able to come to an agreement without having to wait for a fair hearing with the Division of Hearing and Appeals.

You can appeal to the ombudsman by:

  • Calling 1-866-436-0457
  • Writing to:
    MTM, Inc. Quality Management
    5117 W. Terrace Dr., Ste 400
    Madison, WI 53708

If you request an appeal, MTM, Inc. will send you a letter within 10 business days, even if the appeal is not resolved. If the appeal was not resolved within 10 business days, MTM, Inc. will send you a final letter after a decision has been made. The appeal process will not take more than 45 days.

If you are unhappy with how your appeal was resolved, there is further appeal information in the letter MTM, Inc. sends you.

To request a fair hearing with the Division of Hearing and Appeals, complete the Request for Fair Hearing form and send it to:

Department of Administration
Division of Hearings and Appeals
PO Box 7875
Madison WI 53707-7875

If you choose to write a letter instead of using the form, you must include the following:

  • Your name
  • Your mailing address
  • A brief description of the problem
  • The name of the agency that took the action or denied the service
  • Your Social Security number
  • Your signature

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