When you enroll in a HealthPartners Medicare or HealthPartners MSHO plan, you expect the best. And that’s what we’re committed to providing you.
If you’re unhappy with your coverage or have concerns about the quality of your care, you have the right to request an initial determination, appeal the outcome of a coverage decision or file a grievance. If you take any of these actions, we will not penalize you in any way or disenroll you from your plan. We handle all complaints fairly.
Initial determinations, appeals and grievances explained
If you’re unsatisfied with some aspect of your coverage or need to make a request, these processes are the best way to tell us what’s going on.
We’re here to help
If you have questions, need help with a process or want to follow up on an open complaint,
Detailed instructions for requesting an initial determination or filing an appeal or grievance are below.
Requesting an initial determination
You may ask us to make a decision about your benefits, coverage or the amount paid out for your medical services or medicine. Initial determinations may also be called organization determinations or coverage determinations.
Requesting an appeal
If you disagree with our initial determination, you can file an appeal. Appeals are reviewed by someone who wasn’t involved in the initial determination to ensure your request is given an unbiased review.
There are five levels in the appeals process.
Filing a grievance
If you’re unsatisfied with an aspect of your plan that doesn’t involve coverage, such as quality or timeliness of care or service, you can file a grievance.
Have someone else submit an initial determination, appeal or grievance
If you appoint someone as your representative, they can request an initial determination, request an appeal or file a grievance on your behalf. You can appoint anyone to act as your representative, such as a relative, friend, advocate, attorney, physician or someone else you trust.
To appoint a representative,
HealthPartners Member Services
P.O. Box 9463
Minneapolis, MN 55440-9463
Last updated October 2023
H2462 H4882_003671_M Accepted