Health insurance or Medicaid said no in Minnesota? Deadlines and free help

In Minnesota, state-regulated health plans are overseen by Minnesota Department of Health (MDH), Managed Care Systems Section and Minnesota Department of Commerce.

Minnesota runs its own independent review of denials: External Review (External Appeal). You generally have 6 months to ask for it.

External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.

Pick your plan type

Which kind of coverage was denied? The plan type decides which rules and deadlines apply.

Insurance I bought or got through work

Your state insurance rules may apply. First appeal to your plan, then ask for an outside review.

My employer pays claims itself (self-funded)

Federal rules apply, and most state insurance laws do not. Free help comes from the U.S. Department of Labor.

Medical Assistance

You ask the state for a fair hearing. In a Medicaid health plan, you usually appeal to the plan first.

Marketplace (MNsure) decision

A decision about whether you can buy a plan or get financial help is appealed to the Marketplace.

How long do I have?Urgent care: faster decisionWrite my appealFree help

Checked against official sources: October 30, 2026.

Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.

How long do I have in Minnesota?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
6 months
Hearing deadline
30 days
Appeal to the plan first
60 days (federal rule)
Then a state hearing
120 days
Appeal deadline – MNsure
90 days

All the details →

How long do I have? Deadline calculator

How do I know which plan type I have?

How to tell which agency regulates your plan

If your plan is an HMO, the Minnesota Department of Health handles your external review and complaints; other insurance company plans go to the Department of Commerce. If you are not sure whether you are in an HMO, ask your insurance company or MDH. Self-insured employer plans are handled by the U.S. Department of Labor.

Law: Minn. Stat. 62Q.73, subd. 3

Step 1: Appeal to your plan in Minnesota

What it is called: Complaint and appeal with your health plan (for prior-approval denials: appeal of an adverse determination)

You can complain to your plan by phone or in writing. The plan must decide a written complaint within 30 days (it may take 14 more days for reasons outside its control, if it tells you in advance). In a job-based plan you can then appeal in writing or ask for a hearing; the plan must decide within 30 days for a written appeal or 45 days for a hearing. An appeal of a utilization review (prior approval or medical necessity) denial must be decided within 15 days (up to 4 more days in some cases), or within 72 hours for an expedited appeal by phone when your doctor believes it is warranted. You can keep your coverage while the appeal is pending, and before the plan upholds a denial for clinical reasons a physician who did not make the first decision must review it. You can complain to the Department of Health or Commerce at any time.

Law: Minn. Stat. 62Q.69, subd. 2-3; Minn. Stat. 62Q.70, subd. 1-3; Minn. Stat. 62M.06, subd. 1-3

All the details →

Step 2: Outside review in Minnesota

External Review (External Appeal)

Deadline to ask: 6 months.

All the details →

Urgent care in Minnesota: faster decisions

Appeal to your plan

  • Your plan must decide an urgent appeal within 72 hours.

Outside review

You can get an expedited review if waiting for the standard review (or the plan's expedited appeal) could seriously harm your life, health or ability to regain maximum function, or if the denial is about an admission, continued stay or service after emergency care and you have not been discharged. For an HMO, you can ask by phone to MDH, and a health care provider should fill out the expedited section of the form. The reviewer must decide within 72 hours, with written confirmation within 48 hours after that if the first notice was not in writing.

Law: Minn. Stat. 62Q.73; Minn. Stat. 62Q.71

Medicaid

Check the emergency box on the appeal form and explain why, or call. If failing to act could seriously harm your life, health or ability to attain, maintain or regain maximum function, DHS must take final action within 3 working days of your request.

Law: Minn. Stat. 256.045, subd. 3(j)

Marketplace

You can ask for an emergency expedited appeal when health services are needed right away and a standard appeal could put your life or health at great risk or harm your ability to reach, maintain or get back full health. Mark it on the form or call MNsure.

Law: Minn. R. 7700.0105

Complaints about your plan in Minnesota

You can file a complaint with the Department of Health (HMOs) or the Department of Commerce (insurance companies) at any time, even during the plan's process. An MDH complaint does not require an appeal to the HMO first and has no set time limit; you can file it online on the Managed Care Systems Portal.

Law: Minn. Stat. 62Q.69, subd. 3(d); Minn. Stat. 62Q.71

www.health.state.mn.us

Medicaid (Medical Assistance (MA), Minnesota's Medicaid program (MinnesotaCare uses the same appeal office)) denials in Minnesota

Who holds the hearing: Minnesota Department of Human Services, Appeals Division (state human services judges).

Hearing deadline: 30 days

All the details →

Marketplace decisions in Minnesota

Marketplace

MNsure · 1-855-366-7873 (651-539-2099)

Appeal deadline

90 days

The date of the eligibility notice (the notice is presumed to reach you 5 business days after the date printed on it)

How to appeal

Log in to your MNsure account and choose Appeals; or fill out the MNsure Appeal Request Form, sign it, and email it to dhs.mnsureappealsindexing@state.mn.us or mail it to MNsure Legal and Compliance, PO Box 64253, St. Paul, MN 55164-0253; or call the Contact Center; or go in person to the DHS Information Desk, 444 Lafayette Road N, St. Paul. Filing is free. An appeals examiner reviews the case, sometimes at a hearing by phone or in person.

Form

MNsure Appeal Request Form

Faster appeal

You can ask for an emergency expedited appeal when health services are needed right away and a standard appeal could put your life or health at great risk or harm your ability to reach, maintain or get back full health. Mark it on the form or call MNsure.

Coverage while you appeal

Medical Assistance or MinnesotaCare benefits continue if you appeal by the date the change takes effect, or within 15 days of the notice date if the notice came 5 days or less before the change.

Law: Minn. R. 7700.0105

Other rights in Minnesota

How fast a plan must decide a prior approval

A standard prior-approval (utilization review) decision must be made within 5 business days after the plan has the information it needs. An expedited decision must be made as fast as your condition requires and no later than 48 hours. Prior authorization approvals cannot be taken back later except for fraud, misinformation or conflict with law.

Law: Minn. Stat. 62M.05, subd. 3a-3b; Minn. Stat. 62M.07, subd. 3

Care that cannot require prior authorization (from 2026)

For plans issued or renewed on or after January 1, 2026, plans may not require prior authorization for emergency care, outpatient mental health and substance use disorder treatment (except medications), cancer treatment that follows NCCN guidelines (except medications), USPSTF A/B preventive services and recommended immunizations, pediatric hospice, and certain neonatal abstinence programs. An approval for a chronic condition does not expire unless the standard of treatment changes.

Law: Minn. Stat. 62M.07, subd. 2 and 5

Reasons and criteria

When a plan denies care, the written notice must give all the reasons and how to appeal. On request, the plan must give you the criteria it used. If your appeal fails, you can get a complete summary of the review findings, the reviewers' qualifications and how your diagnosis relates to the criteria.

Law: Minn. Stat. 62M.05, subd. 3a(c); Minn. Stat. 62M.06, subd. 3(f)

How long do I have? Deadline calculator

Pick your plan type and enter the dates on your notice. We count from the rules in Minnesota and the federal rules.

Worked out in your browser. Nothing you enter here is saved or sent.

If you are not sure when it arrived, use the date printed on the notice. That date is never later than the day it arrived.

Choose what was decided and enter the date on your notice

We add the number of days or months from the law to your date. Nothing is saved.

Write my appeal: free letters

Free help in Minnesota

Good to know in Minnesota

  • Minnesota gives 6 months (not 4) to ask for external review, and the external review decision binds the plan but not you.

    Law: Minn. Stat. 62Q.73, subd. 3(d) and 8

  • The Medical Assistance hearing deadline is 30 days after you receive the notice, or up to 90 days with good cause.

    Law: Minn. Stat. 256.045, subd. 3(j)

  • In a Medical Assistance hearing on a medical issue you can ask for an expert medical opinion from the state's external review organization, paid by DHS.

    Law: Minn. Stat. 62Q.73, subd. 2(b)

Changes in 2024–2026

2024 laws (2024 c 127, c 121) changed prior authorization and external review: from January 1, 2026, Medical Assistance fee-for-service is listed among the government programs not covered by state external review, and prior authorization is banned for several kinds of care and chronic-condition approvals no longer expire. A prior-authorization API is required from January 1, 2027. DHS bulletins list a temporary extension of MA and MinnesotaCare eligibility-appeal deadlines (Bulletin 25-21-02, February 21, 2025), six-month renewals for certain adults (Bulletin 26-21-08) and the end of MA for certain noncitizen adults from October 1, 2026 (Bulletin 26-21-06).

Law: Minn. Stat. 62Q.73, subd. 2; 62M.07; 62M.07, subd. 4(b)

Questions about appeals in Minnesota

How long do I have to appeal a health insurance denial in Minnesota?

Minnesota law does not set a longer time to file. Use the deadline on your denial notice; federal rules give at least 180 days for most plans. You have at least 180 days (about 6 months) from when you receive the denial notice to file an internal appeal.

How do I get an outside (external) review in Minnesota?

External Review (External Appeal). For an HMO: file online on the MDH Managed Care Systems Portal (no login needed), or complete the MDH External Appeal form and email it to health.mcs@state.mn.us or mail it to Minnesota Department of Health, Managed Care Systems Section, P.O. Box 64975, St. Paul, MN 55164-0975. For an insurance company plan: send a written request to the Minnesota Department of Commerce, 85 7th Place East, Suite 280, Saint Paul, MN 55101 (consumer.protection@state.mn.us).

Is outside review free in Minnesota?

The health plan company pays the cost of the external review.

How long do I have to ask for a Medicaid fair hearing in Minnesota?

30 days. The date you receive the written notice

Can I keep my Medicaid benefits while I appeal in Minnesota?

If the notice reached you 10 days or more before the change, your benefits continue if you appeal by the date the change takes effect. If you got the notice 5 days or less before the change, appeal within 15 days of the date of the notice to keep your benefits.

How do I appeal a Marketplace decision in Minnesota?

Log in to your MNsure account and choose Appeals; or fill out the MNsure Appeal Request Form, sign it, and email it to dhs.mnsureappealsindexing@state.mn.us or mail it to MNsure Legal and Compliance, PO Box 64253, St. Paul, MN 55164-0253; or call the Contact Center; or go in person to the DHS Information Desk, 444 Lafayette Road N, St. Paul. Filing is free. An appeals examiner reviews the case, sometimes at a hearing by phone or in person.

Not about a denied claim?

Nearby states

Sources

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