Appeals and grievances

This section provides an explanation of how members can file a complaint. Hennepin Health wants to assure members that they have all the information to express their dissatisfaction. The following are definitions that will help you understand the meaning of complaints:

APPEALS are complaints that should be made when:

A claim is denied, yet you receive a bill
You want a service to be covered and Hennepin Health denied the service that was requested
You are not happy with a service being reduced or terminated

A DENIAL, TERMINATION, REDUCTION (DTR) is a notice you will receive when:

A claim is denied
A request for authorization is denied
A service is reduced
A service is terminated

GRIEVANCES are complaints that should be made when:

You have a concern about the quality of care you have received
Your rights have not been respected
A provider or employee is rude to you
Appropriate treatment or referral is delayed

A STATE APPEAL, also known as a STATE FAIR HEARING is a member’s request for the state to review a decision Hennepin Health made about:

A denial or limited authorization of the type or level or service
A denial of all or part of a payment for a service
Hennepin Health’s failure to act within required timelines for service authorizations and appeals
Any other action

Filing time lines

When filing a grievance, appeal or state appeal, you must adhere to the below time lines. If you go over the time allowed, Hennepin Health may not review your grievance or appeal, and the State may not accept your request for a hearing.

You must file a grievance within 90 days from the date of the incident about which you are complaining.
You must file an appeal within 90 days from the date on the DTR issued on or before 12/31/2017.
You can file a state appeal also known as a state fair hearing at the same time.
You must request a state appeal also known as a state fair hearing within 30 days from the date on the DTR or within 30 days from the date of the resolution of your appeal. You have up to 90 days if you have a good reason for being late.

Changes to the appeals and grievances process, effective 1/1/18

You can file a grievance at any time from the date of the incident.
You must file an appeal within 60 days from the date on the DTR issued on or after 1/1/2018.
You must file an appeal first with Hennepin Health.
If Hennepin Health takes more than 30 days to make a decision about your appeal and does not ask for an extension, you can ask for a state appeal or state fair hearing.
You can ask for a state appeal in writing within 120 days of Hennepin Health’s decision.

How to start the complaint process

To receive assistance with your complaint, you must first document your request. This can be done by either speaking with a Hennepin Health member services representative or filling out and mailing back an appeals and grievances form (PDF). While either option is acceptable, Hennepin Health encourages members to call member services first since that is the fastest way to start the process. One exception to filling out the authorization form is if your physician is appealing on your behalf prior to you receiving services – then you do not need to fill out the authorization form.

Contact information

Hennepin Health

Minneapolis Grain Exchange Building
400 South Fourth Street, Suite 201
Minneapolis, MN 55420

To speak with a Hennepin Health member services representative, call 612-596-1036.

If you choose not to file a complaint with Hennepin Health first, you may also contact the Ombudsman for State Managed Health Care Programs to file a complaint or request a state fair hearing. Additionally, members may file a complaint with the Minnesota Department of Health.

Minnesota Department of Human Services

Ombudsman for State Managed Health Care Programs
P.O. Box 64249
St. Paul, MN 55164-0249

Phone: 651-431-2660 (Twin Cities metro area); 1-800-657-3729 (toll-free); 1-800-627-3529 (TDD)

Minnesota Department of Health

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

Phone: 651-201-5100 (Twin Cities metro area); 1-800-657-3729 (toll-free)