Health Care

To help Minnesotans navigate the health care insurance system when problems arise, we have put together a handbook entitled "Managing Your Health Care" which contains an overview of private health coverage and tips on how to assert your rights when it comes to your health care insurance.

Medical Billing

Medical billing can be confusing. The terms used by insurance companies—phrases like “provider allowed amount,” deductible, co-pay, and co-insurance—can be puzzling. Moreover, some patients are billed incorrectly or for services they never received, that were already paid, or that should have been submitted to an insurance company. Others may have difficulty keeping up with large medical bills. Our flyer entitled "Medical Billing Pointers," has tips on how to ensure your medical bill is accurate, as well as information about payment and financial assistance plans and billing and collection practices.

This Office and most Minnesota hospitals have entered into an agreement relating to the hospitals’ billing and collection practices. Below are some of the provisions in the Minnesota Attorney General Hospital Agreement:

• The hospital cannot collect a debt from a patient unless the applicable insurance company has been billed and given the opportunity to pay the claim and there is a reasonable basis to believe the patient owes the bill.
• The hospital must offer a reasonable payment plan to patients who are unable to pay the full amount in one payment. The hospital cannot refer a debt to a collection agency if the patient makes payments in accordance with the terms of a payment plan agreed to by the hospital.
• The hospital must give patients a reasonable opportunity to submit an application for financial assistance from the hospital.
• The hospital’s collection agency must forward all patients who object to the collection activity to the hospital. In other words, a patient has a right to speak with the hospital directly about the debt.
• The hospital’s collection agency must cease collection activity pending further review if a patient states that: (1) he or she doesn’t owe the bill; (2) the insurance company is obligated to pay the bill; or (3) the patient needs further documentation of the bill.
• The hospital cannot charge patients without insurance more than it would be reimbursed by its largest insurer for those with health insurance. In other words, an uninsured patient cannot be charged more than an insured patient.

Medical Assistance

Medical Assistance (Minnesota’s Medicaid program) provides medical assistance to low income citizens, children and families, and people with disabilities. To qualify for Medical Assistance, residents must meet income and asset limit eligibility guidelines. For more information about these eligibility requirements, you should contact your county’s human services agency. To view a directory of these agencies by county, visit the Minnesota Tribal and County Human Services Directory. You can also call the Minnesota Health Care Programs Help Desk at (651) 431-2670 or (800) 657-3739. Additional information about Medical Assistance, including application instructions, is available from the Minnesota Department of Human Services.

MinnesotaCare

MinnesotaCare is a health care program for Minnesota residents who do not have access to other health care insurance. Most enrollees pay a monthly premium and may have co-pays for certain services. As with Medical Assistance, applicants must meet eligibility guidelines to qualify for MinnesotaCare. For additional information about these eligibility requirements, you should contact your county’s human services agency. Contact information for these agencies can be found in the Minnesota Tribal and County Human Services Directory. You may also call the Minnesota Health Care Programs Help Desk at (651) 431-2670 or (800) 657-3739. More information about MinnesotaCare, including application instructions, is available from the Department of Human Services.

Hospital Status

A common misconception among people is that when you spend time in a hospital, you are automatically admitted as a patient, or an “inpatient,” at the hospital. Yet, even after spending the night in a hospital room, some people learn that they were not really “admitted” to the hospital. Instead, they learn that the hospital classified them as being under “observation.” Being classified as under “observation” can impact Medicare recipients in at least three ways. First, Medicare covers “observation” status stays at hospitals under Medicare Part B, which charges higher co-pays than Medicare Part A. Second, if the patient needs prescription drugs while in the hospital on “observation” status, Medicare will not cover the high cost of these drugs. Third, if a patient requires care at a skilled nursing facility following the hospital stay, he or she must be an inpatient for at least three days before Medicare will pay for any costs at the skilled nursing facility. For more information on this topic, see our flyer entitled "Know Your Hospital Status."

New Requirements for Certain Health Care Entity Transactions

On May 26, 2023, Governor Walz signed into law specific reporting requirements for certain health care entity transactions. Minnesota Statutes, sections 145D.01 and 309.715, available at 2023 Minnesota Laws Chapter 66 – H.F.No. 402. These requirements took effect May 26, 2023. For more information on this topic, see our webpage "New Requirements for Certain Health Care Entity Transactions "

Additional Resources

Information about the availability of health insurance and health care can be found on www.healthcare.gov, a website maintained by the federal government.

If you have a question or experience a problem related to medical billing or health insurance, we want to hear from you. Complaints from members of the public help us to identify potential violations of Minnesota law and new problems occurring in the health care marketplace. In addition, we can sometimes help people solve problems they are having with a medical bill or their insurance company. If you would like to file a complaint with this Office, please submit a completed Consumer Assistance Request Form to:

Office of Minnesota Attorney General Keith Ellison
445 Minnesota Street, Suite 600
St. Paul, MN 55101

The Minnesota Attorney General’s Office offers the following materials, which are designed to provide information to Minnesota citizens about health care related topics:

State Boards

The State of Minnesota has several boards that license different medical professionals (e.g. chiropractors, nurses, doctors, dentists, etc.). To file a complaint against a licensed medical professional, you may contact the following boards, as applicable:

Minnesota Department of Health

The Minnesota Department of Health (MNDOH) licenses and regulates HMOs in Minnesota. If your health insurance is through an HMO, you may file a complaint with the Department of Health as follows:

Minnesota Department of Health
Office of Health Facility Complaints
85 East 7th Place
PO Box 64975
Saint Paul, MN 55164
(651) 201-4201
www.health.state.mn.us

To file a complaint regarding a licensed hospital, nursing home, assisted living or home health agency, you should contact the Department of Health’s Office of Health Facility Complaints as follows:

Office of Health Facility Complaints
P.O. Box 64970
St. Paul, MN 55164-0970
(651) 201-4201 or (800) 369-7994

Minnesota Department of Commerce

The Minnesota Department of Commerce (MNDOC) has some authority to regulate certain health insurance companies and third-party administrators in Minnesota. If your self-insured plan uses a third-party administrator, or your health insurance coverage is through a health insurance company, you may file a complaint with the Commerce Department as follows:

Minnesota Department of Commerce
85 7th Place East, Suite 280
St. Paul, MN 55101
(651) 539-1500 (local)
(800) 657-3602 (Greater MN only)
www.mn.gov/commerce

United States Department of Labor Employee Benefits Security Administration

The Department of Labor Employee Benefits Security Administration (EBSA) has authority to regulate self-insured plans. The State of Minnesota does not have authority to directly regulate self-insured plans. To file a complaint about a self-insured plan, you may contact the EBSA as follows:

Employee Benefits Security Administration
Kansas City Regional Office
2300 Main Street, Suite 1100
Kansas City, MO 64108
(816) 285-1800 or (866) 444-3272
www.dol.gov/agencies/ebsa