Any policyholder in Minnesota has the right to file an appeal on a claim that has been denied without good reason. In many cases, there has been a mistake in using the proper service code for the type of care you received, and it shows up to an insurer as a benefit your plan does not cover. In other events, it may be that the service is not covered by your plan after all. Making sure you know what happened and how to resolve the situation is very important, and sometimes requires a formal appeal.
The first action to take is discussing the matter with your health insurance company, who can help you understand what happened, or you can inform them that perhaps a mistake was made. Speaking directly to an agent is essential in making progress, as they should be able to provide the answers you need. Certain situations may not resolve easily enough after talking with your health plan, and you have the option of writing an appeal to send through the Minnesota Department of Commerce.
Other reasons you may feel the need to make a formal complaint against your insurer or a particular agent may also arise. Regardless of the issue, always talk to your insurer first. If you cannot reach an agreement with a satisfactory outcome, you can request that the Minnesota Department of Commerce intervene and provide you assistance. You will have to fill out a complaint form and they will require you to have spoken previously with your health plan before they proceed with your complaint.
Contact Your Health Insurance Company
Below are listed either the customer service contact numbers or the direct link to complaints and appeals through each Minnesota health insurer. You can also find the contact number on the reverse side of your member ID.
Contact the Department of Commerce
If you and your insurance company cannot resolve your issue, you may ask the Minnesota Department of Commerce Consumer Response Team for help. These investigators will attempt to adequately resolve your dispute by acting as a middle man between you and your insurance company. When they receive your complaint and all copies of necessary documents, the CRT holds a thorough review. Upon completion of the review, the Department of Commerce will send you a synopsis stating the results of their review. They are unable to force insurers to pay claims, but they can help consumers get a better understanding of their case.
To contact the Minnesota Department of Commerce, you must fill out a formal complaint after speaking with your insurer.
1. Minnesota Department of Commerce. “Insurance Complaints.” http://mn.gov/commerce/insurance/consumers/tools/complaints/insurance-complaints.jsp.