State guide
Minnesota
Pick the kind of plan you have to see who to call first. Minnesota can only help with plans it regulates.
Which plan do you have? Who to call first, by coverage
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Your employer pays claims itself
Minnesota usually cannot help with these plans. Call the Employee Benefits Security Administration.
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Insurance you buy, or an employer plan bought from an insurer
Call Minnesota Department of Commerce. See the at-a-glance box.
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Medicaid or children's coverage
Call the number on your notice and ask to appeal, and to keep services going while you appeal. The hearing deadline is under Medicaid in Minnesota.
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Medicare
Minnesota Aging Pathways (formerly the Senior LinkAge Line), Minnesota's State Health Insurance Assistance Program gives free counseling. Or call 1-800-MEDICARE.
The short version for Minnesota
Minnesota splits oversight: the Department of Health handles health maintenance organizations (HMOs) and the Department of Commerce handles insurance companies, so the first step is finding out which one covers your plan. External review is free, you have six months to ask, and the result binds the insurer but not you, so you can still go to court if you lose. Minnesota has no federally listed Consumer Assistance Program.
At a glance: independent review for plans Minnesota regulates
- Main regulator
- Minnesota Department of Commerce · 651-539-1600 or 1-800-657-3602 (Greater Minnesota); choose the Insurance option (option 3)
- Independent review
- A state process (External review (the Department of Health calls it an external appeal))
- Deadline to request it
- 6 months from the date of the adverse determination (the denial you are appealing)
- Cost
- none (the Department of Commerce says it is free to apply; state law puts the cost on the health plan company)
- Decision time
- 45 days; fast track: 72 hours
Who regulates health plans
If your health plan company is an HMO, external review goes to the Minnesota Department of Health; if it is an insurance company, it goes to the Minnesota Department of Commerce. The Minnesota Attorney General's Office says to contact it for help if you are unsure whether your plan is self-insured, fully insured, an HMO or an insurance company. Commerce says that if you are not sure, submit the paperwork anyway and it will help with next steps.
- Minnesota Department of Commerce
Health plans sold by insurance companies (plans that are not HMOs), including individual plans and fully insured employer plans. It does not regulate self-insured employer plans, Medicare, Medical Assistance or MinnesotaCare.
Phone: 651-539-1600 or 1-800-657-3602 (Greater Minnesota); choose the Insurance option (option 3). File a complaint online
- Minnesota Department of Health (MDH), Managed Care Systems Section
Fully insured plans issued by Minnesota health maintenance organizations (HMOs).
Phone: 651-201-5100 or 1-800-657-3916. File a complaint online
Independent (external) review
- Process
- A state process. Run by Minnesota Department of Commerce (insurance company plans) or Minnesota Department of Health (HMO plans); each sends the case to a contracted independent review organization.
- Where you file
- regulator
- How
- Insurance company plan: email the Health Insurance External Review Appeal form and your last denial letter to consumer.protection@state.mn.us (or fax 651-539-0105 or mail it to the Department of Commerce). HMO plan: file online through the Department of Health's Managed Care Systems Portal (no account needed) or send its External Appeal form.
- Which denials qualify
- Denials of a health care service or claim that were upheld on internal appeal, including medical necessity denials, denied prior authorizations, and denied step therapy overrides. The decision is binding on the health plan company but not on you.
- Appeal to the plan first?
- Yes, in most cases you must first complete an appeal with your health plan. An expedited external review is available if waiting would seriously jeopardize your life, health or ability to regain maximum function (you must also have asked the plan for an expedited appeal), or for emergency services when you have not been discharged.
Free help in Minnesota
- Office of the Minnesota Attorney General
Helps consumers work out what kind of health plan they have and which agency handles it, and takes contacts about health coverage problems.
Phone: (651) 296-3353 (Twin Cities) or (800) 657-3787
Medicare and Medicaid in Minnesota
- Medicare counseling
- Minnesota Aging Pathways (formerly the Senior LinkAge Line), Minnesota's State Health Insurance Assistance Program · 1-800-333-2433 . Free help with Medicare appeals.
- Medicaid agency
- Minnesota Department of Human Services (Medical Assistance and MinnesotaCare); state appeals are heard by the Department's Appeals Division
- Fair hearing deadline
- 30 days after receiving the notice of action (up to 90 days with good cause); if you are in a health plan, 120 days from the date of the plan's appeal decision. Your notice states the deadline that applies to you.
- Good to know
- If you are in a Medical Assistance or MinnesotaCare health plan you must appeal to the plan first, within 60 days of the date on its notice; if the plan takes more than 30 days you can go straight to a State Appeal. To keep services, appeal within 10 days. In a State Appeal about a medically necessary service you can ask for an expert medical opinion from an outside reviewer. File online with the Appeal to State Agency form (https://edocs.dhs.state.mn.us/lfserver/Public/DHS-0033-ENG), by fax (651-431-7523) or by mail.
State laws that can help
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External review. You have six months to request external review, the health plan company must take part and pay for it, a decision is due within 45 days (72 hours if expedited), and the result binds the plan but not you.
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Step therapy. Health plans must grant a step therapy override on listed grounds, must respond within five days (72 hours in urgent cases) or the override is granted, and a denial upheld on appeal can go to external review.
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Prior authorization. For plans issued or renewed on or after January 1, 2026, an authorization for treatment of a chronic health condition does not expire unless the standard of treatment for that condition changes.
Sources and what we could not confirm
- External Review Process (Minnesota Department of Commerce)
- Health Insurance External Review Appeal Form, June 2024 (Minnesota Department of Commerce)
- Appeal Process - HMO Enrollee External Appeals and Complaints (Minnesota Department of Health)
- Minnesota Statutes section 62Q.73
- Managing Your Health Care: Appeals (Office of the Minnesota Attorney General)
- Minnesota Health Care Programs Eligibility Policy Manual 1.3.1.1 Appeals
- Health plan appeal and State Appeal rights notice (DHS-8041)
- Minnesota listing (SHIP National Technical Assistance Center)
- CMS: State External Appeals Review Processes
- CMS: Consumer Assistance Program
Not confirmed (8)
- The state regulators. most mn.gov pages could not be loaded (automated-access wall); this Department of Commerce address is as returned by a search index and may redirect
- The state regulators. the Department's online complaint page could not be loaded; the printable life and health complaint form is given instead
- The cost of independent review. official pages disagree: the Department of Commerce says it is free, while the Attorney General's handbook still says there is a $25 filing fee (waivable for hardship); a 2025 news report says the fee was dropped on August 1, 2024
- How long a fast independent review takes. the Department of Commerce form says an expedited review 'is not required by law' and that the insurer cannot be forced to take part, while section 62Q.73 requires an expedited decision within 72 hours
- The Medicare counseling program's web page. the state's Minnesota Aging Pathways site could not be loaded; the federal SHIP directory page is given instead
- The Medicaid fair hearing page. the Department of Human Services public appeals page could not be loaded; the official eligibility policy manual page is given instead
- Published results of independent review. no officially published overturn rate found
- Free consumer help programs. the federal directory lists no Consumer Assistance Program for Minnesota