New to helping someone in Minnesota?
You do not need a law degree to help someone fight a health insurance denial. Start by gathering three basic documents:
- Insurance card — shows which company administers the plan. Use the name and phone number on the card when you call or file paperwork (it may differ from an employer or clinic name).
- Denial letter or explanation of benefits (EOB)— the notice that says a service was denied, not paid, or needs approval first. Look for appeal instructions and a deadline. On an EOB alone, search for words like "denied," "adverse determination," or "appeal."
- Summary of Benefits and Coverage (SBC) — a plain-language summary of what the plan covers. It helps you tell whether the fight is about medical necessity or whether the benefit exists at all.
Your first tasks: identify what type of plan this is (MNsure individual/family, job-based, Medical Assistance, Medicare) and write down the appeal deadline from the letter. Missing a deadline is one of the most common reasons people lose appeals they could have won.
Minnesota law uses terms like adverse determination and complaint. You usually start with the plan's internal appeal (or complaint process). If that fails, you may request external review through the Minnesota Department of Health (MDH) or Minnesota Department of Commerce, depending on who regulates your carrier.
For steps that work in every state, read these general guides first, then return here for Minnesota rules:
- Denial decoder — what the denial letter is actually saying
- Appeals roadmap — internal appeal, then external review
- Building a strong appeal packet — records and letters to gather
What is different in Minnesota?
- MNsure Marketplace: Minnesota runs its own exchange at MNsure.org. Major individual-market carriers include Blue Plus, Medica, UCare, HealthPartners, and Quartz. The insurer on your ID card handles prior authorization and appeals.
- Prior authorization (Minn. Stat. ch. 62M): 5 business days for standard PA / 48 hours (including at least one business day) for expedited PA; PA appeals often within 15 days (§ 62M.05–62M.06). Starting in 2026, many outpatient mental health, substance use, and cancer services cannot require PA at all (§ 62M.07).
- Internal complaints & appeals: Written complaints often within 30 days (§ 62Q.69); group internal appeals within 30 days (written) or 45 days (hearing) (§ 62Q.70). Many individual plans may go to external review after a complaint decision without a separate internal appeal level.
- External review (§ 62Q.73): File within 6 months of the adverse determination; standard decision within 45 days; expedited within 72 hours when health is at risk. Binding on the plan (not on you).
- Medical Assistance (Medicaid): MCO appeal first, then state fair hearing with DHS— separate from Commerce/MDH external review.
Who is in charge of your plan?
The right agency depends on plan type and whether your carrier is an HMO (regulated by MDH) or another insurer (regulated by Commerce). When in doubt, call member services and ask whether the plan is "fully insured in Minnesota" or "self-funded ERISA."
- Minnesota Department of Commerce:Many indemnity and accident & sickness insurers; external review for plans it regulates — Commerce — external review. Consumer Services: 651-539-1600 or 800-657-3602.
- Minnesota Department of Health (MDH): HMOs and managed care; HMO external appeals — MDH — HMO external appeal. Managed Care Systems: 651-201-5100 or 800-657-3916.
- U.S. Department of Labor: Many self-funded employer plans.
- DHS fair hearings: Medical Assistance, MinnesotaCare, and prepaid MA— dhs.state.mn.us, fair hearing request form DHS-0033; generally 30 days to request (90 with good cause) under Minn. Stat. § 256.045.
- CMS: Medicare and Medicare Advantage.
After appeals are exhausted, see Regulator complaints.