Grievances and Appeals

A state appeal is a meeting held by a human services judge (from the MN Department of Human Services Appeals office) with you and South Country Health Alliance. Your meeting will be by telephone unless you ask for a face-to-face meeting.

If you are appealing South Country Health Alliance’s decision to deny, terminate, or reduce a service, or South Country Health Alliance’s decision to deny payment of a claim, and this decision by South Country Health Alliance occurred on or after January 1, 2018, you must appeal to South Country Health Alliance before asking for a state appeal (if you are appealing a decision that occurred on or before December 31, 2017, the applicable requirements and appeal rights for 2017 will be followed).

You must request a state appeal in writing within 120 days after the date of the appeal resolution letter that you received from South Country Health Alliance. You must ask for a state appeal within 10 days of our appeal decision if you want to continue the service during your state appeal, or before the service is stopped or reduced, whichever is later. You must ask to keep getting your services. If you lose your state appeal, you may have to pay for these services, but only if state policy allows this.

If South Country Health Alliance takes more time than what is required to give you a decision to your appeal request, and an extension has NOT been added to the appeal timeframe, you do NOT need to wait for an appeal decision from South Country Health Alliance to ask for a state appeal.

A State Managed Care Ombudsman can provide education and assistance with filing a grievance, appeal or state appeal. You can call or write to the Ombudsman for State Managed Health Care programs any time during this process.

Managed Care Ombudsman Hotline: 1-800-657-3729 or 1-651-431-2660

Or write:
Minnesota Department of Human Services
Ombudsman for State Managed Health Care Programs
PO Box 64941
St. Paul, MN 55164-0249

You can also file a complaint with the Minnesota Department of Health.

Call: 1-800-657-3916 (toll free)

Or write:
Minnesota Department of Health Health
Policy and Systems Compliance Division Managed Care Systems
PO Box 64882
St. Paul, MN 55164-0882

For complete details on the Appeals and Grievances process, see your Evidence of Coverage or Member Handbook. For members of SeniorCare Complete and AbilityCare, see Chapter 9. For members of Medical Assistance, Minnesota Senior Care Plus, MinnesotaCare, SingleCare, or SharedCare see Section 13.