HMO Enrollee External Appeals and Complaints
There are several reasons why an enrollee may be dissatisfied with a decision made by their health maintenance organization (HMO). The issue may be simple or complex and may relate to past, current or future health care claims. If you have been denied coverage, believe your access to providers is limited or are dissatisfied with how you have been treated or served - you have options:
Submit an External Appeal or Complaint Online
Managed Care Systems Portal
No login or account is required to file an appeal or complaint online.
For help with the process, see the step-by-step instructions: Filing an Appeal or Complaint online (PDF) (December 2025)
Use of Artificial Intelligence (AI)
If you use AI to assist in preparing documents or information submitted, please carefully review all materials prior to submission. AI-generated content frequently contains inaccuracies, incomplete information, or incorrect references to laws, regulations, or policy provisions that may not be applicable to your specific circumstances. Submission of inaccurate, repetitive, or irrelevant information may delay or complicate our office’s ability to efficiently review and investigate the matter and may result in longer response times.
Should I submit a complaint to the Minnesota Department of Health or request an appeal?
In making this decision, you may want to consider the following factors:
How long can you wait for a decision?
The Minnesota Department of Health (MDH) recommends you start with an appeal through your HMO. This first appeal (sometimes called a first-level or internal appeal) usually takes the HMO up to 30 days to make a decision. Complaints/grievances filed through your HMO can take up to 45 days to resolve.
For an external appeal, you must first file an appeal through your HMO. After your appeal with your HMO, external appeals may take up to 45 days. However, 72-hour expedited external appeals are available in situations where the HMO’s denial could harm your health. HMOs also have an expedited appeal option.
Complaints filed with MDH do not have a limit on how long they take, and do not require you to file an appeal with your HMO first.
How long has it been since your HMO made the decision you disagree with?
External appeal requests must be filed within six months of the decision you are appealing. After six months, you only have the right to file a complaint with the Minnesota Department of Health (MDH).
Does your concern involve issues of complex, unproven, experimental or investigative medical treatment or otherwise require expert medical advice?
If so, consider filing an external appeal. MDH contracts with Independent Review Organizations (IROs) who have readily available medical experts who will make a decision within 45 days. Expedited decisions are also available, allowing for a decision within 72 hours. The decision must be based on all documents submitted.
Does the issue in your complaint affect other enrollees as well as you?
Decisions reached in an appeal affect only the enrollee who filed the appeal request. If the issue might impact other enrollees, consider filing a complaint. MDH can enforce decisions beyond a single enrollee, and an HMO can appeal the State of Minnesota's decision through an administrative hearing and ultimately to state court.
I don't know anything about the law. How do I know that my complaint is a legal issue or that it is handled correctly?
MDH has experience investigating complaints filed by HMO enrollees. The staff understand state laws that govern Minnesota health plan companies. If you aren’t sure, you can always contact the MDH, and they can help you determine which option is best.
