External Review – MINNESOTA

Who should I call if I have any questions about filing a complaint?

You can contact the Minnesota Department of Health at (651) 201-5100 or (800) 657-3916. The Department of Health is open from 8:00 a.m. to 4:30 p.m., Monday through Friday. You can contact the Minnesota Department of Commerce at (651) 539-1600...

What happens after the Department of Commerce receives my complaint?

The Department of Commerce will investigate your complaint and determine whether the insurance company is in compliance with state law. If the Department suspects that the insurer has violated a law or regulation, it can pursue enforcement action against the...

How do I file a complaint with the Department of Commerce?

If your health plan is with an insurance company and your coverage is still denied after the external review process, you can file a complaint with the Minnesota Department of Commerce. Your complaint should include the following information: The name,...

What happens after the Department of Health receives my complaint?

Your complaint will be assigned to an investigator who will determine whether the HMO’s actions are in compliance with state law. If the Department suspects that the HMO has violated a law or regulation, the Department will refer your complaint...

How do I file a complaint with the Department of Health

If your health plan is an HMO and your coverage is still denied after the external review process, you can file a complaint with the Minnesota Department of Health. You can find a copy of the complaint form here. Your complaint...

How long will the external review process take?

The external review process should take no more than 45 days after the case is received by the external review organization.[27] If you requested an expedited external review, the process should no longer than 72 hours after your request is received.[28]

How do I request an external review?

You should file your request for an external review within six months from your insurer’s most recent decision.[19] If your plan is a health maintenance organization (“HMO”), you should file your request with the Minnesota Department of Health. If your health...

In what circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[14] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. You can request an appeal in the following situations: Your...

How long should the internal appeals process take?

The internal appeals process should take a maximum of 45 days for both group and individual health plans.[12] The expedited appeals process should take no longer than 72 hours after your health insurer receives the expedited appeal request.[13]

How do I file a complaint and request an internal appeal?

Group plans. If you have a group health plan, you must first file a formal complaint with your health insurer before requesting an internal appeal.[1] Your complaint may be submitted orally (by phone) or in writing directly to your health insurer.[2] Your member...

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