Medicare determinations, appeals and grievances

When you enroll in a HealthPartners UnityPoint Health Medicare plan, you expect the best. And that’s what we’re committed to providing you.

If you’re unhappy with your coverage or have concerns about the quality of your care, you have the right to request an initial determination, appeal the outcome of a coverage decision or file a grievance. If you take any of these actions, we will not penalize you in any way or disenroll you from your plan. We handle all complaints fairly.

Initial determinations, appeals and grievances explained

If you’re unsatisfied with some aspect of your coverage or need to make a request, these processes are the best way to tell us what’s going on.

Initial determinations

An initial determination is a decision we make about your benefits, coverage or the amount we will pay for your medical services or medicine. Initial determinations are also called organization determinations or coverage determinations.


An appeal (or request for reconsideration) is a formal way of asking us to review information and change an initial determination we already made.


A grievance is any complaint that does not involve a determination, including concerns about the quality or timeliness of the care you received.

We’re here to help

If you have questions, need help with a process or want to follow up on an open complaint, contact Member Services. Our Member Services team can also tell you the total number of grievances, appeals and exception requests we’ve received.

Detailed instructions for requesting an initial determination or filing an appeal or grievance are below.

Requesting an initial determination

You may ask us to make a decision about your benefits, coverage or the amount paid out for your medical services or medicine. Initial determinations may also be called organization determinations or coverage determinations.

Requesting an appeal

If you disagree with our initial determination, you can file an appeal. Appeals are reviewed by someone who wasn’t involved in the initial determination to ensure your request is given an unbiased review.

There are five levels in the appeals process.

Filing a grievance

If you’re unsatisfied with an aspect of your plan that doesn’t involve coverage, such as quality or timeliness of care or service, you can file a grievance.

Having someone else submit an initial determination, appeal or grievance

If you appoint someone as your representative, they can request an initial determination, request an appeal or file a grievance on your behalf. You can appoint anyone to act as your representative, such as a relative, friend, advocate, attorney, physician or someone else you trust.

To appoint a representative, fill out this form (PDF) from the Centers for Medicare & Medicaid Services. Then fax it to us at 952-883-7333 or mail it to us at:

HealthPartners Member Services
MS 21103R
P.O. Box 9463
Minneapolis, MN 55440-9463

Legal information

Last updated October 2023
H3416_003672_M Accepted