Minnesota Department of Health HMO Complaint Process
1. 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 sends a letter to the complainant explaining the nature of the resolution.
2. 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.
3. 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.
4. Investigations are conducted in accordance with the Minnesota Government Data Practices Act and most are completed within 30 - 60 days.
5. At the conclusion of the investigation, the investigator informs the complainant of the investigation via letter and/or phone contact.
6. 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.
Click on the link to 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.