Complaint and Appeals Options, Forms and Process

There are several reasons, situations and appeal options when an enrollee is dissatisfied with their health plan. It may be something as simple as being charged an improper copayment or as complex as seeking coverage for an innovative procedure to treat a rare condition. Either way, if you have been denied any type of coverage, feel your rights have been infringed upon or are dissatisfied with how you have been treated or served -you have options.

1.  Health plan complaint and appeal - Minnesota law requires each Health Plan Company to establish an internal process whereby enrollees can complain about any action taken by their Health Plan Company. The complaint process can be initiated via phone call or written communications to the Health Plan Company's member service department. If the enrollee's complaint is not resolved to his or her satisfaction, the enrollee has the right to file an appeal with the Health Plan Company. Both complaint and appeal process are provided at no cost to enrollees.

2.  Minnesota Department of Health complaint - Health Plan Company enrollees have the right to file complaints with the Minnesota Department of Health. The complaint process can be initiated via phone call or written communication. We can investigate to determine if the Health Plan Company and its providers have acted consistent with applicable law and with the terms of the enrollee’s health plan. Our investigation can take place at the same time as the Health Plan Company's internal complaint and appeal process. There is no cost to file a complaint with the Minnesota Department of Health.

    There are two options for completing and printing the Complaint Form:

  • Print and complete complaint form (PDF:38kb:5 pages)
    Allows you to print a paper copy of the form to be completed and mailed back to MDH

  • Print and/or complete complaint form online (MSWord:5 pages)
    Allows you to complete the form online, save a copy with a new file name to your computer files, and then email an electronic copy or send a paper copy to MDH via US Mail.

3.  External Review - The State of Minnesota contracts with an independent third party to review appeals for Health Plan Company's enrollees who are dissatisfied with the Health Plan Company’s internal complaint and appeal process. External Review is available after the internal appeal process has been exhausted. There is a $25 fee for each External Review unless it is waived for hardship.

4.  Pursue Legal Action - You always have the right to seek legal counsel or to have an attorney assist you in pursuing your complaint and appeal options. However, once litigation has begun, the Department of Health can no longer investigate your complaint.


Link to Adobe Acrobat Reader To view the PDF files, you will need Adobe Acrobat Reader (free download from Adobe's website).

 

For more information, or to file a complaint, contact MCS section at (651) 201-5100 or 1-800-657-3916.

Updated Thursday, 27-Oct-2011 10:59:21 CDT