Minnesota Department of Health HMO Complaint Process
There are two options for completing and printing the Complaint Form:
- Print and complete HMO complaint form (PDF: 61KB/5 pages)
Download and print a paper copy of the form to be completed and mailed back to MDH.
- Print and/or complete HMO complaint form (Word: 646KB/5 pages)
Download and complete electronically, then email or mail a copy to MDH.
- When the complaint is received by phone, MCS staff reviews the issue and
determines if it might be resolved quickly and/or informally. If so,
MCS staff contacts the HMO to initiate an informal resolution. If successful,
MCS communicates to the complainant the nature of the resolution.
If the complaint is not resolved by phone, a complaint form will be
sent to the complainant. When the completed form is returned it is assigned to an investigator.
The assigned investigator investigates the complaint to determine:
the nature of the complaint and the desired resolution; whether the
issue falls within the jurisdiction of the Department of Health or should
be referred to another agency; what information is needed to investigate
this complaint; whether the decision or action of the health plan relative
to the complainant's issue is in compliance with the applicable statutes,
rules, and the enrollee's certificate of coverage; and what actions,
if any, are necessary to bring the HMO into compliance with applicable
law or rule and the enrollee's certificate of coverage.
- Investigations are conducted in accordance with the Minnesota
Government Data Practices Act and most are completed within 30
- 60 days.
At the conclusion of the investigation, the investigator
informs the complainant of the investigation via letter and/or phone
- If a violation of law, rule or contract is suspected, the complaint will be referred for possible enforcement action which may include a penalty and/or a corrective action plan.
Read more about Quality of Care complaints.
For more information, or to file a complaint, contact MCS section at (651) 201-5100 or 1-800-657-3916.