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Appeals and grievances

Do you have a request for coverage or concerns about the care you received?

When you enroll in a HealthPartners Medicare plan, you expect the best. And that’s what we’re committed to providing you. If you want us to review your request for coverage, or if you have concerns about the quality or timeliness of your care, we want to know.

If you make a complaint, we’ll be fair in how we handle it. You won’t be disenrolled in your plan or penalized in any way.

A coverage decision is a decision we make about your benefits, coverage or the amount we will pay for your medical services or medicine. (You may also hear this referred to as an organization determination.) If you disagree with a coverage decision, you can appeal our decision.

What’s the difference between an appeal and a grievance?

  • An appeal is a formal way of asking us to review information and change our decision. You can ask for an appeal if you want us to change a coverage decision we already made.
  • A grievance is any complaint other than one that involves a coverage decision. Grievances include concerns about the quality or timeliness of the care you received.

How it all comes together: Our first decision about the medical care you want is called a coverage decision. If you disagree with the decision we make, you can appeal the decision. This is also called requesting a reconsideration. If you’re unhappy with the quality of the care we provided, you can file a grievance.

Can someone else file an appeal or grievance for me?

Yes. A representative can file an appeal or grievance on your behalf. You can appoint anyone to act as your representative. Your representative could be a relative, friend, advocate, attorney, physician or someone else you trust.

Read more about appointing a representative. Fill out this form from the Centers for Medicare and Medicaid Services site and send it to us.

How do I make a request?

You can find instructions for requesting coverage, filing an appeal or filing a grievance:

Curious about the total number of grievances, appeals and exceptions we’ve received? Contact Member Services for the numbers.

From October 1 through February 14, we take calls from 8 a.m. to 8 p.m. CST, seven days a week. You’ll speak with a representative. From February 15 to September 30, call us 8 a.m. to 8 p.m. CST, Monday through Friday to speak with a representative. On Saturdays, Sundays and Federal holidays, you can leave a message and we’ll get back to you within one business day.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary.

HealthPartners is a health plan that contracts with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. HealthPartners is also a Cost plan and PPO plan with a Medicare contract. Enrollment in HealthPartners depends on contract renewal.

Last updated June 2018

H2422 H2462 H4882_110915 Pending

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