Resolve problems with your health plan

Resolve problems and grievances with health care programs

If you have been denied a service, or a service has been reduced or terminated, you can file an appeal with the health plan and request a state appeal. You can also file an appeal with the health plan and request a state appeal if the health plan is denying payment for a service you got. You must file an appeal with your health plan before you request a state appeal.

How do I file a health plan appeal?

  • It is easy to appeal. You can simply call the health plan and tell them that you disagree with their decision. The phone number is on the notice you got and on the back of your health plan ID card.
  • The health plan can help you with your questions and help you file the appeal.
  • You must file your appeal within 60 days after the date on the health plan notice about the action.
  • If you want to continue getting services while your appeal is considered, you must file an appeal within 10 days after the date of the health plan notice.
  • You will get a written decision within 30 days after you file the appeal.
  • Health plans overturn many decisions on appeal.
  • The Ombudsperson for Public Managed Health Care Programs can give you advice about filing an appeal.

Is your appeal urgent?

  • If you want to appeal the denial of an urgently needed service, you can ask for a fast appeal.
  • If the health plan agrees that the appeal is urgent, you will get a decision within 72 hours.
  • If the health plan disagrees that your appeal is urgent, you may file a grievance.

State appeals

What is a state appeal (state fair hearing)?

During a state appeal, a neutral state appeals staff person listens to your concerns, considers the health plan information and makes a written decision.

  • You must request a state appeal in writing within 120 days after the date of the health plan appeal decision.
  • If you want to continue getting services while your appeal is considered, you must file an appeal within 10 days after the date of the health plan appeal decision.
  • If you have information you want the appeals staff to see, you can include it with your Appeal to State Agency form. If you get any more related documents after you file your appeal, you must provide them to the state appeals staff and the health plan.
  • The Ombudsperson for Public Managed Health Care Programs can help you request a state appeal and can advise you about how to prepare for your hearing.

How do I file a request for a state appeal?

You can submit your request online or by mail or fax. Complete the online or paper version of the Appeal to State Agency form.

If you complete the printed form, mail or fax it to this address or fax number:
Minnesota Department of Human Services
Appeals Division
PO Box 64941
St. Paul, MN 55164-0941
Fax number: 651-431-7523

Health plan appeals can also be made verbally by calling the Appeals Division at 651-431-3600.

Grievances

What is a grievance?

A grievance is the same as a complaint. Filing a grievance does not affect your health care program benefits. Examples of grievances include:

  • The quality of care you got from a provider is not what you think it should be.
  • You believe the health plan or a provider was rude to you.
  • You believe your rights were not respected.
  • You do not have sufficient access to providers.

How do I file a grievance?

If you have a grievance, call your [health plan member services] and tell them what happened.

  • You can file your grievance orally. You will get an oral response from the health plan within 10 days.
  • You can file your grievance in writing. You will get a written response from the health plan within 30 days. If you need help writing your grievance, the health plan must help you.