Prior Authorized Medical Services

Medical Services (Including Treatment)
When you are enrolled in a health plan, you must receive all your medical services through that health plan's providers or have a referral from the health plan to go outside of the network for medical services.  Most billing problems are the result of not following this rule.  If you have billing issues or problems getting services covered, please call your Member Services phone number on the back of your Health Plan card.  If you have fee-for-service MA, commonly referred to as "straight MA", call the Member Services telephone number on the back of your MN Healthcare Programs card. 

Some services will require your provider to get prior authorization from your health plan or the Minnesota Department of Human Services prior to providing you the service.

If insurance denies coverage for a certain medical service, your first step is to contact Member Services on the back of the health plan card.   If this does not help to resolve your issue,  our county advocate will direct you to the Minnesota Ombudsman's Office at 800.657.3729, and you may file an appeal.