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Complaints and Appeals

For Medica Medicare Supplement (Signature Solution) Members

 

Do you have a concern?

If you have a concern, we encourage you to call Medica Customer Service first. We'll do everything we can to resolve your concern over the phone.

Call 1-866-810-5032 (TTY: 711)

We will try to resolve any complaints that are delivered verbally — either over the phone or in person — within 10 days.

What if my concern isn’t resolved?

If your concern is not resolved, you may choose to take additional steps, including:

  • Filing a written complaint (grievance)
  • Filing an appeal
  • Submitting a Complaint to the Minnesota Commissioner of Commerce 

Below, we'll walk you through how to complete the next steps.

 

Written Complaints and Appeals

A written complaint (grievance) is a complaint that is formally submitted in writing. Complaints may include:

  • Quality of care
  • Waiting times
  • Customer service
  • Other concerns

Filing a written complaint with Medica means that you would like us to address your complaint. 

Within 30 days of receiving your written complaint and all necessary information, we'll notify you in writing of our decision and the reasons for the decision.

If we are unable to make a decision within 30 days due to circumstances outside our control, we may take up to 14 additional days to make a decision. If this happens, we'll inform you in advance of the reasons for the extension.

To submit a written complaint to Medica, download, fill out and return our complaint form:

If you disagree with a coverage decision, you may file an appeal of the decision in writing and request either a hearing or a written reconsideration.

For full information on your rights for complaints and appeals, please see your Policy of Coverage.

Complaints About Medicare Payment of Services

If your complaint involves a dispute relating to the payment of services covered by Medicare, you may file a Medicare appeal through Medicare. The process to file a Medicare reconsideration are explained in the Explanation of Medicare Benefits (EOMB) or Medicare Summary Notice (MSN) forms which can be obtained from Medicare. You may also contact the Social Security office at 1-800-772-1213.



Submitting a Complaint to the Commissioner of Commerce

At any time, you have the right to direct complaints about benefits to the Minnesota Commissioner of Commerce, either in person or in writing.

Commissioner of Commerce – Minnesota Department of Commerce



Appoint a Representative

You may authorize an individual to act on your behalf. Simply download and complete the Appointment of Representative form below. Both you and your representative will need to sign the form. When it is complete, you can submit it along with your determination, appeal or grievance or send it to the same the location where you already sent your determination, appeal or grievance.




Last Updated: May 2019

Date: 7/13/2020 4:16:20 AM Version: 4.0.30319.42000 Machine Name: PWIM4-CDWEB01