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:

Complaint and Review Process

HMO Appeals

If you disagree with a decision made by your HMO, you can take the following steps:

Health Maintenance Organization internal appeal - The first step in the Appeals process is to file an internal appeal with your HMO. The appeals process can be initiated via phone call or written communication to the HMO’s Member Services Department. The appeal process is provided at no cost to enrollees.
Minnesota Department of Health external appeal - Enrollees have the right to file an appeal with their HMO and with the MN Department of Health. If the internal appeal was denied, you have the right to contact the Department of Health to file an External Appeal (also called an External Review). The state of Minnesota contracts with up to three independent third parties that can provide an appeal for HMO enrollees who are dissatisfied with the HMO’s appeal decision. To file an external appeal, complete the External Appeal form (PDF).
Pursue legal action - If you are dissatisfied with the outcome of the External Appeal, you have the right to seek legal counsel or to have an attorney assist you in resolving the issue in court.

HMO Complaints

Health Maintenance Organization internal complaint - Minnesota law requires each HMO to establish an internal process whereby enrollees can complain about any action taken by their HMO. The complaint process can be initiated via phone call or written communications to the HMO's Member Services Department. The complaint process is provided at no cost to enrollees.
Minnesota Department of Health complaint - HMO enrollees have the right to file complaints with the Minnesota Department of Health. The complaint process can be initiated via phone call or downloading and completing the HMO Complaint Form (PDF) electronically, which you may mail or email to MDH. We can investigate to determine if the HMO and its providers have acted consistent with applicable law and with the terms of the enrollee's health plan. Our investigation can take place at the same time as the HMO's internal complaint and appeal process. There is no cost to file a complaint with the Minnesota Department of Health.
Pursue legal action -You always have the right to seek legal counsel or to have an attorney assist you in pursuing your complaint and appeal options. However, once litigation has begun, the Department of Health can no longer investigate your complaint.