You have the right to appeal the outcome of a coverage decision we made when you had health insurance with us.

You, your health care provider or your authorized representative can fill out the HealthPartners complaint/appeal form (PDF) and return it to us via email (DRT@healthpartners.com), fax (952-883-9646, ATTN: Appeals) or mail (HealthPartners Appeals, MS 21104G, PO Box 1309, Minneapolis, MN 55440-1309).

• Please include all information that’s requested, including what you’re requesting and why, the best phone number to reach you during the day, your email address (if you’d like to get the outcome of your appeal via email), and any other information you’d like us to consider, such as comments, documents or records that support your request.
• If you’re appealing a denied authorization for future care, you can also call us at 800-331-8643 (TTY 711). We’re available Monday through Friday, 8:30 a.m. to 4 p.m. CT.
• If we denied coverage for urgently needed services based on our medical necessity criteria, you can request an expedited review by noting your expedited request on the appeal form.
• In most cases, you must send us your appeal request within 180 calendar days of our original decision. The original decision date is the date of a denial letter or the date of an explanation of benefits (EOB) statement, whichever comes first.

After we receive your appeal request, we’ll review it and respond. Within 15 or 30 days (depending on your plan), you’ll get a letter via mail or email with our decision and explanation.

• If we can’t respond to you within the required timeframe due to circumstances beyond our control, we’ll let you know. In such cases, we may need four to 14 additional days.
• If you requested an expedited review and waiting the standard review time would jeopardize your life or health, you’ll get a response within 72 hours.

If we can’t fully approve your appeal, we’ll provide information and directions regarding further appeal options available for your plan, such as external reviews. If all required reviews of your claim have been completed and your appeal still hasn’t been approved, most members have the right to bring a civil action under section 502(a) of the Employee Retirement Income Security Act of 1974.