Appeals and complaints (grievances)

Our plan products are designed to help you take care of your health. There may be a time when you don’t agree with our decision to deny, reduce or terminate a service. Or you may be dissatisfied with a service or process you received. You can make an appeal or file a complaint (grievance).

If you choose to make an appeal or file a complaint, it will NOT affect your eligibility for medical benefits.

Your Member Handbook has full details on how to file a complaint or make an appeal.
PMAP member handbook | MNCare member handbook | SNBC member handbook

How to make an appeal

You will receive a letter from us when:

A claim is denied.
A request for a service authorization is denied.
A service is reduced or terminated.

1. File an appeal with Hennepin Health first

If you disagree with the service change or denial, you can file an appeal with us.

You must file your appeal within 60 days from the date on the letter.
There is no cost to you to file an appeal.
Tell why you disagree with the decision. Tell us if you need a decision quickly.
You can have a relative, friend, advocate or provider help with your appeal. Anyone may appeal on your behalf with your written consent.

Ways to file your appeal with us

Call:
Call Member Services at 612-596-1036.

TTY 800-627-3529

Write:
Download the appeals/grievance form

Complete and return to:
Hennepin Health
300 S 6th St MC 604
Minneapolis, MN 55487-0604

2. Ask for a state appeal

You can also make a state appeal (also called a state fair hearing). You must appeal to Hennepin Health first before asking for a state appeal.

If we take more than 30 days to decide your appeal and we have not asked for an extension, you do not need to wait for our decision to ask for a state appeal or state fair hearing.
You must ask for a state appeal within 120 days of our decision on your appeal.

Contact:

Minnesota Department of Human Services
Ombudsman for State Managed Health Care Programs
P.O. Box 64249
St. Paul, MN 55164-0249
Call: 651-431-2660, 800-657-3729, TTY: 711
Fax: 651-431-7472
Website

How to make a complaint (grievance)

If you are not satisfied with a service or a process, you can file a complaint with us.

If you file a complaint by phone, we will let you know our decision within 10 days.
If you send us a written complaint, we will let you know our decision within 30 days. We will respond to you by letter.

Ways to make your complaint with us

Call:
Call Member Services at 612-596-1036.

TTY 800-627-3529

Write:
Download the appeals/grievance form

Complete and return to:
Hennepin Health
300 S 6th St MC 604
Minneapolis, MN 55487-0604

File your complaint with MDH

If you do not agree with our decision, you can file your complaint with the Minnesota Department of Health.

Contact
Minnesota Department of Health
Health Policy and Systems Compliance Monitoring Division
Managed Care Systems
P.O. Box 64882
St. Paul, MN 55164-0882

Call: 651-201-5100, 800-657-3916, TTY: 711

DHS approved 9/24/2020 ID #HC-1110-MC