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- Finding Information
- Billing
- General Coverage
- Life Changes
- Student and Child Coverage
- Emergency Coverage
- Disability Coverage
- Prior Approvals and Referrals
- About Us
- Complaints and Appeals
The Service You Deserve
At HealthPartners, we're committed to providing you with the service you deserve. Browse our FAQ section and, if you still have questions, contact Member Services at 800-883-2177 or email us.
Finding Information
How can Member Services help me?
Member Services can answer questions about your medical, dental and FSA plans, benefits, claims and other plan information. Our hours are 7 a.m. - 7 p.m., Monday - Friday.
For information about personal medical issues, such as test results, opinions about specific treatments or recommendations for care, call your clinic directly.
How can I check the status of my claims?
Log on to your secure member site to check the past two years of your medical, dental and pharmacy claims.
Billing
What if I am billed incorrectly?
If you are billed for services that should be covered by your plan, a bill is incorrect or you are billed for services you didnt receive, contact Member Services.
What should I do with a medical bill for care I received outside of the United States?
Submit bills for urgent or emergency care to:
HealthPartners Medical Claims Department
P.O. Box 1289
Minneapolis, MN 55440-1289
Routine or preventive care typically is not covered when provided out-of-network. Log on to your secure member site to view your benefits and see which services are covered by your plan. You may also check your Membership Contract or Summary Plan Description.
General Coverage
How does my out-of-pocket maximum work?
It limits how much you pay out-of-pocket for coinsurance and deductibles for covered services. Once you reach your annual out-of-pocket maximum, your plan covers 100% of additional eligible expenses. You pay any amount that exceeds your benefit maximums, fair and reasonable costs or lifetime maximums. Log on to your secure member site to view your specific benefits. You also may check your Membership Contract or Summary Plan Description.
Why did I receive a coordination of benefits form?
When more than one health plan or insurance carrier may be responsible for payment, you need to complete a Coordination of Benefits form. This may occur, for example, with an injury that could be covered by workers compensation or by automobile insurance. The information on the form helps determine which insurer is responsible for a claim.
How and when should I file a claim?
Usually, your provider will submit the claim for you. If you need to file a claim yourself, do so as soon as possible. (Check your Membership Contract or Summary Plan Description for your filing limits.)
Submit the itemized bill, including your diagnosis and the procedures and services you received, to:
HealthPartners Claims
P.O. Box 1289
Minneapolis, MN 55440-1289
Am I covered when out of town?
If you have an out-of-network option (check your benefits on your web account to see if you have this option), you may see any provider for non-preventive care and it will be covered at the out-of-network benefit level. Generally, HealthPartners plans do not cover routine or preventive care provided out-of-network.
Emergency services performed by licensed providers outside the United States are covered.
If you are hospitalized and the facility is not part of your care network, you or a family member should call the CareCheckSM program at 800-942-4872 within two business days, or as soon as reasonably possible, to make sure that you receive the maximum benefit coverage your plan offers.
HealthPartners also offers a nationwide pharmacy network. If you need a prescription while traveling out-of-network, you can show your identification card at any participating pharmacy chain and be covered at the network benefit level.
What if I need preventive or routine care while traveling?
In most cases, HealthPartners plans do not cover routine or preventive care provided out-of-network. Schedule these services with your primary care doctor or clinic before traveling. If you need follow-up care while outside of the network area, your primary physician or clinic must recommend care and request prior approval from HealthPartners before you travel. With an out-of-network option, care is covered anywhere at the out-of-network benefit level.
Log on to your secure member site or check your Membership Contract or Summary Plan Description to view your specific benefits.
Does everyone in the family have to use the same clinic?
For plans that require a primary clinic selection, each family member may choose a different primary clinic within the plan's network. Open Access plans (check your plan information on your web account) don't require selection of a primary clinic, so each family member can see any network provider at any time.
How often can you change benefits plans?
Employer-sponsored plans: Employers generally hold open enrollment annually.
Individual plans: You may change at any time. Changing from a higher to a lower deductible requires underwriting review and approval; switching from a lower to a higher deductible does not.
How do I add or drop dependents from coverage?
Employer-sponsored plans: You should contact your employer's Human Resources department to add or drop a dependent from coverage. Eligible dependents may be added during open enrollment or within a specified time following a qualifying event (marriage, for example). Newborns and adopted children are covered by your plan immediately but you must add the child(ren) to your plan. The employer will submit the form to HealthPartners.
Individual plans: To remove a dependent from coverage, you should fax a written request to 952-883-5950 or submit the request in writing to:
HealthPartners Membership Accounting
P.O. Box 297
Minneapolis, MN 55440-0297
You may apply to add the eligible dependents to your individual plan at any time, but the new dependents must provide evidence of insurability and be approved by underwriting. Call Individual Sales at 952-883-5600 or 800-247-7015 to request an application.
Does my plan have a lifetime maximum on benefits?
Lifetime maximums can range from $1 million to unlimited, depending on the specific plan and benefit options chosen. Check your benefits information on your web account. You may also check your Membership Contract or Summary Plan Description.
Life Changes
What happens to my coverage if I move out of the service area?
Employer-sponsored plans: If membership in the plan's network is required and no network providers are available, you should consider other health plan alternatives. If the plan offers an out-of-network option, you may continue coverage using that alternative.
Individual plans: If the plan requires use of in-network providers and none are available in your new area, HealthPartners will terminate coverage.
What happens to my coverage if I quit a job, get laid off or get fired?
Employer-sponsored plans: You should check with your employer, as policies vary. At a minimum, you have the right to continue coverage for 18 months following termination under the federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). You may also apply for individual coverage.
Individual plans: Coverage will continue as long as you pay premiums and reside within the plan's service area.
What happens to my coverage when I turn 65 or retire?
HealthPartners sends information about coverage options to you about three months before your 65th birthday.
Employer-sponsored plans: Coverage generally continues if you keep working. If you are retiring, you should ask your employer if a retirement plan is offered. If a plan is not offered, you may be eligible for COBRA benefits and continue coverage under the group plan for 18 months after retiring. You also may want to explore our Medicare options.
Individual plans: You may continue coverage or explore our Medicare options.
What if I divorce?
The divorced spouse previously covered as a dependent may continue coverage. The duration of benefits varies among plans. Coverage may continue indefinitely until eligibility ends due to an event such as plan termination or failure to pay premium. COBRA laws also allow for continuation of coverage.
Student and Child Coverage
Can students attending college out-of-state receive coverage?
Network-Only Plans (check your benefits information on your web account): Students are covered for non-emergency services only when received from a network provider. For emergency/urgently needed care out-of-network, we cover professional services of physicians, urgent care treatment, emergency room treatment and inpatient hospital services. Covered services are subject to all of the benefit limitations set forth in the contract. Out-of-network coverage stops when treatment for the condition no longer meets the definition of emergency care or urgently needed care, or when the members condition permits him or her to receive care within the network.
Plans with Out-of-Network Options (check your benefits information on your web account): For routine or preventive care, students should see their in-network physician. Non-preventive care and non-urgently needed/emergency care may be received at any out-of-network provider at the appropriate lower benefit level. For emergency/urgently needed care out-of-network, we cover professional services of physicians, urgent care treatment, emergency room treatment and inpatient hospital services. Covered services are subject to all of the benefit limitations set forth in the contract. Out-of-network coverage stops when treatment for the condition no longer meets the definition of emergency care or urgently needed care, or when the members condition permits him or her to receive care within the network.
How long can children remain covered?
With employer-sponsored plans, the length of time dependents may remain covered varies from plan to plan.
With individual plans, dependents may be covered up to age 25. Coverage may be extended if the dependent is disabled.
Log on to your secure member site to view your specific benefits. You may also check your Membership Contract or Summary Plan Description.
Emergency Coverage
Is urgent or emergency care covered?
All HealthPartners plans cover both urgent care and emergency care. Log on to your secure member site to view your specific benefits. You may also check your Membership Contract or Summary Plan Description.
What do I do in case of an emergency?
Call 911 if necessary. Go the nearest hospital emergency room.
If you are hospitalized and the facility is not part of your care network, call the CareCheckSM program at 800-942-4872 within two business days or as soon as reasonably possible to ensure that you receive the maximum benefit coverage your plan offers.
What should I do if I need urgent care?
Call your clinic during regular clinic hours.
After clinic hours, call:
HealthPartners CareLineSM Service:
612-339-3663 (Twin Cities metro)
800-551-0859 (outside Twin Cities metro)
952-883-5474 (TTY)
952-883-7789 (collect if outside North America)
A specially trained nurse will answer your call, assess your problem and direct you to the most appropriate provider or facility. You may visit any urgent care clinic listed in your provider directory, or you may follow your clinic's after-hours urgent care instructions.
Log on to your secure member site to view your specific network.
What emergency coverage do I have while I am traveling?
All HealthPartners plans cover both urgent care and emergency care. If you need emergency medical care while traveling, call 911 if necessary or go to the nearest hospital emergency room.
If your plan has an out-of-network option, you may see any provider and services will be covered at the out-of-network benefit level. Log on to your secure member site or check your Membership Contract or Summary Plan Description to view your specific benefits.
Disability Coverage
What if a dependent or I become disabled?
Benefits vary depending on the plan. In any case, you may continue coverage using COBRA and Family Medical Leave Act (FMLA) benefits. Disabled dependent children may be entitled to remain on the parents policy. Check with your employer for complete details or contact Member Services.
How long can a disabled child remain covered?
In most cases, you can continue a disabled dependents coverage as long as your own coverage remains in force. You must request and receive continuation of coverage when your dependents coverage would normally end.
Employer-sponsored plans: If your coverage ends, your disabled childs coverage generally can continue for 18-36 months, depending on the plan.
Individual plans: If your individual coverage ends, the dependent with disabilities can then be converted to an individual policy with no underwriting.
Log on to your secure member site to view your specific benefits. You may also check your Membership Contract or Summary Plan Description.
Prior Approvals and Referrals
What services require prior approval?
Prior approval occurs when HealthPartners reviews and approves proposed procedures before they are performed to assure that you are covered. The majority of medical procedures are eligible for benefits without review. Fewer than 70 procedures require approval. View the entire list of services that require prior approval.
Vision Services: HealthPartners provides you direct access with no referral to more than 300 vision care providers within the HealthPartners Vision Network. Routine eye exams are always covered. No referral is necessary if you use a network provider.
Behavioral Health (mental health / chemical health): No referral is necessary. You may make appointments directly with any mental health/chemical health provider in the HealthPartners Mental health/Chemical health Network.
Chiropractic Services: With most plans, you have direct access to all chiropractic clinics in the HealthPartners Chiropractic Network. Check your plan information on your web account. No referral is necessary. To be covered by the plan, chiropractic services must be medically necessary for treatment or rehabilitation of acute musculoskeletal conditions.
Most plans cover medically necessary chiropractic services provided by HealthPartners network chiropractors.
Durable Medical Equipment: Certain durable medical equipment (DME) items are covered, others are excluded, and some items require prior approval or special circumstances to be covered. You can view the HealthPartners DME criteria list.
How do I get prior approval?
Physicians typically make prior approval requests on behalf of the patient. If all necessary information is presented, you will be notified of the decision by mail within 10 business days.
About Us
What accreditation does HealthPartners have?
The National Committee for Quality Assurance (NCQA) awarded HealthPartners "Excellent" Accreditation for its commercial HMO, point-of-service, and Medicare+Choice plans. NCQA is an independent, nonprofit organization dedicated to measuring the quality of America's health care.
NCQA's "Excellent" status, the highest level of accreditation, is awarded only to health plans that deliver care and service that meet or exceed NCQA's rigorous requirements for consumer protection and quality improvement.
NCQA's accreditation process evaluates how well a health plan manages all parts of its delivery system to continuously improve health care for its members. Its surveys include rigorous evaluations of more than 60 standards and performance measures.
How does HealthPartners credential providers?
HealthPartners reviews the credentials of providers who want to join a HealthPartners provider network. This is in compliance with NCQA standards and all applicable state and federal laws, rules and regulations.
HealthPartners credentialing system ensures that highly qualified and competent professional staff will meet our members health care needs. Individual health care professionals must meet specific, objective criteria to ensure professional competency and receive credentials from HealthPartners.
HealthPartners credentials individuals upon application for participation in the network, and verifies those credentials every two to three years thereafter as specified by regulatory and accreditation requirements. Providers must meet qualifications in nine areas, including education, licensing, experience, registrations, malpractice history, insurance and more. Providers must also meet continuing education requirements as designated by their specialty or industry.
Complaints and Appeals
How can a member file a complaint against a provider?
You may submit complaints to Member Services either verbally or in writing. If the complaint cannot be resolved through a phone call, we will promptly send the member a complaint form to complete and return. Member Services will then investigate and notify the member of our initial decision within 30 days of receipt of the claim form. Subsequent appeal procedures vary by plan type. You may also complain to the clinic.
How do I appeal a denial of authorization for care?
Contact Member Services by phone or in writing with all the information you wish to be considered. Further appeal procedures vary by plan type.
How do I appeal a claim payment or denial?
Contact Member Services by phone or in writing with all the information you wish to be considered. Further appeal procedures vary by plan type.
What if waiting for an appeal decision would harm my health?
You may request expedited reviews or appeals. When contacted by phone, Member Services will respond as quickly as possible no later than 72 hours after receiving your request. Appeal procedures vary by plan type.
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