Patient Rights and Process for Dispute Resolution

Your primary care physicians are your advocates when working with the health plans, even though they face incentives to modify their treatment and referral patterns. Clear communication with your physician and your health plan can many times address any needs or concerns that you may have. It is unlikely that you will have to use more formal methods to resolve any issues, but there are legal and regulatory resources at your disposal if necessary.

If you are dissatisfied with or have concerns about the care that you are receiving, there are consumer protections required in Minnesota legal statutes and rules. Some of the requirements for complaint procedures of HMOs and health plans administered by Blue Cross can be found in Chapters 62D.11 and 62Q.105 of the Minnesota Statutes and in Chapter 4685 of the Minnesota Rules. Minnesota law requires HMOs and health plans to notify enrollees of their complaint procedures. For enrollees in Medica Primary, HealthPartners Plan, HealthPartners Classic, and First Plan Select, you have the following rights:

1. To work directly with your physician and your health plan to resolve issues,
2. To receive a statement of the HMOs complaint policy and procedures,
3. To submit complaints to an HMOs internal review process,
4. To receive the HMOs decision regarding the complaint within 30 days, and
5. To appeal the decision by the HMO to the Minnesota Department of Health.

You should first work with your physician and health plan to resolve any issues on an informal basis. You may want to review your health plan materials and contact the University of Minnesota Employee Benefits office for more information. You may also want to contact the Minnesota Department of Health to learn more about the complaint process (phone number and web pages listed in Appendix 2).

Problems that arise under the State Health Plan, State Health Plan Select, and First Plan Select must be handled in a different manner, because these plans are self-insured and are exempt from state regulations. You should first contact your physician or health plan to identify and resolve the problem. If you need to address a problem or issue with these health plans and/or their physicians, you should contact the Minnesota Department of Employee Relations. This state agency can help you resolve any issues that have not been satisfactorily addressed by working directly with your physician and health plan.