Due to the COVID-19 outbreak, the Department of Labor (DOL) and Internal Revenue Service (IRS) have extended deadlines for members to file claims for benefits, appeal adverse benefit determinations and file requests for external review. Under agency guidance, certain time periods must be disregarded when determining applicable deadlines – the disregarded period is the earlier of one year or the end of the outbreak period (July 10, 2023). If you have questions about a specific deadline applicable to your situation, please contact Member Services.
If you have concerns about your coverage or the care you’ve received, you have the right to file a complaint or to appeal the outcome of a coverage decision. We handle all complaints and appeals according to state and federal guidelines.
Complaints and appeals, explained
What’s a complaint?
A complaint is any grievance you have about your HealthPartners insurance. Examples of complaints include concerns about your care or coverage, the service you received or the timeliness of the service.
What’s an appeal?
An appeal is a formal request to review information and ask for a change in a decision we’ve made about your coverage.
Keep in mind that your HealthPartners insurance may not cover all your health care expenses. Please read your membership contract carefully to determine which expenses are covered and at what benefit level – some services may require prior authorization as part of
If you do choose to file an appeal, you’ll receive a full and fair review. For example, if you’re disputing a decision made by a medical director, doctor or other staff person, a different doctor or staff person will review your request to help ensure an unbiased review.
How to file a complaint with us
The complaint process depends on what kind of HealthPartners plan you have:
- If you have a Medicare plan with us, get more information about
Medicare determinations, appeals and grievances.
- If you have a Medical Assistance (Medicaid) plan with us, call
866-885-8880(TTY 711) for more information.
- If you have any other plan with us, you can register a complaint by calling Member Services at the number on the back of your member ID card or
800-883-2177. If we can’t resolve your complaint over the phone, we’ll explain your options for submitting an appeal. After we receive your appeal request, we’ll follow up with you regarding the action we took.
How to file an appeal with us
The appeal process depends on what kind of HealthPartners plan you have:
1. Send us your appeal request
To appeal a decision about care you’ve already received, you, your health care provider or your authorized representative can fill out the
To appeal a denied authorization for future care, you, your health care provider or your authorized representative can fill out the
If we denied coverage for urgently needed services based on our medical necessity criteria, you can request an expedited review by noting your expedited request on the appeal form or when you call us.
2. Wait for our response
After we receive your appeal request, we’ll review it and respond.
Within 15 or 30 days (depending on your plan), you’ll get a letter via mail or email with our decision and explanation. If we can’t respond to you within the required timeframe due to circumstances beyond our control, we’ll let you know – in such cases, we may need four to 14 additional days.
If you requested an expedited review and waiting the standard review time would jeopardize your life or health, you’ll get a response within 72 hours.
Have questions or need help?
Call Member Services at the number on the back of your member ID card or