Grievances and Appeals

What is a “grievance”?

A “grievance” is when you have a problem with South Country Health Alliance, one of our programs, or one of our plan providers, about the services you received or what care is covered.

What is an “appeal”?

An “appeal” is when you want us to reconsider and change a decision we have made about what services or benefits are covered for you, or what we will pay for a service or benefit.

The process for filing a grievance or appeal with South Country is detailed in your Certificate of Coverage. Many problems can be resolved with a phone call to South Country Member Services. Member Services will assist you in filing a grievance or appeal if you want their help. Keep in mind a grievance or appeal must be submitted within certain time limits, as specified in your Certificate of Coverage.

There are forms below for submitting either a grievance or appeal that you can print and mail to us at:            

Complaints, Appeals, and Grievances
South Country Health Alliance
110 West Fremont Street
Owatonna, MN 55060

Or fax to: 1-507-444-7774

Or call Member Services to file a grievance or appeal. Call 1-866-567-7242 (toll free). Those who are hearing impaired should call 711.

You can also call or write to the Ombudsman for State Managed Care Programs at the Minnesota Department of Human Services to request a State Fair Hearing. You can ask for a State Fair Hearing at any time during the process, and you do not have to file an Appeal or Grievance with South Country before you ask for a State Fair Hearing.

Call:  1-800-657-3729 (toll free) or 1-651-431-2260

Or Write:
Appeals Office/Department of Human Services         
PO Box 64941
St. Paul, MN 55164-0941

How to get an aggregate number of grievance, appeals and exceptions filed with South Country

For complete details on the Grievance or Appeals process, see your Certificate of Coverage. For members with Medicare (SeniorCare Complete and AbilityCare with Medicare), see Chapter 9. For members without Medicare (Medical Assistance, Minnesota Senior Care Plus, MinnesotaCare, AbilityCare without Medicare) see Section 13.

To find out about the total number of Grievances, Appeals, and exceptions received by South Country Health Alliance for your program, call Member Services at 1-866-567-7242 (toll free), 7 days a week, 8 am – 8 pm. TTY users call 711 (toll free).

For AbilityCare and SeniorCare Complete Members WITH Medicare

• Medicare Member Grievance and Appeals Form (.pdf)
• While we encourage you to contact South Country Member Services first when you have a grievance, you can also tell Medicare about your grievance directly here or contact the Office of the Medicare Ombudsman at the link here.
  

For Medical Assistance, MinnesotaCare, Minnesota Senior Care Plus, and AbilityCare members WITHOUT Medicare

• Member Grievance and Appeals Form (.pdf)

Last Updated: 10-21-11
H5703_1747, H2419_1747, CMS Approved 7-31-2011
H2419_1736, H5703_1736, CMS Approved 7-30-2011
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South Country Health Alliance is a Coordinated Care plan with a Medicare Advantage
contract and a contract with the Minnesota Medical Assistance program.