Submitting an Appeal or Grievance or Requesting a State Fair Hearing
You may file an appeal or grievance to HealthPartners Member Services over the phone or in writing. If you request an appeal over the phone (oral appeal), we will send you a complaint form. The form should be signed and returned to us. If you need help completing the form, Member Services will help you and will send the form to you for your signature.
You may have a relative, friend, advocate, provider or lawyer help with your grievance, appeal or State Fair Hearing. A provider may appeal on your behalf with your written permission. Your attending health care professional may appeal on your behalf without your written permission. The request must be received within 90 days.
Member Services will review your complaint. You will receive our decision within 30 days of your oral or written appeal or written grievance. If we can’t make a decision within 30 days due to conditions that we can’t control, we may take up to 14 additional days to make the decision. We will send you a letter and tell you if we need extra time and why.
What happens if you are not satisfied with the decision?
You have more rights. You may file a State Fair Hearing. A State Fair hearing is a hearing with the state related to the delivery of health services, denial of a claim or service, failure to make an initial determination in 30 days and/or any other action.
If our decision involves stopping or reducing a service, you can continue to receive the service. However, to do so, you will need to take action. You will need to file a health plan appeal or a State Fair Hearing within ten days of the date the decision was issued, or before the service is stopped or reduced, whichever is later.
Also, the treating provider must agree the service should continue. The service can continue until the appeal or State Fair Hearing is resolved. If you lose the appeal or State Fair Hearing, you may have to pay for the services you used between your initial and final denial.
You must tell Member Services in writing if you want to appeal our first decision. You may ask for a written reconsideration or hearing before the HealthPartners Board of Directors Member Appeals Committee. If you have questions, please call Member Services at 952-967-7029 or 1-888-820-4285 between 8 a.m. and 6 p.m., Monday through Friday. TTY users can call 952-883-6060 or 1-800-443-0156.