If you qualify for a Medical Assistance (MA), you may need to choose a health plan (see below) to receive health care services. Most plans will also ask you to choose a primary clinic.
Member Services: 952-967-7998
Member Services: 952-992-2322
Metropolitan Health Plan (MHP)
Member Services: 1-800-647-0550
Member Services: 612-676-3200
Hennepin County managed care team
Get help with enrollment questions, billing questions, or complaints and HMO issues.
You should know
Medical Assistance recipients are required to participate in managed care. There are some exceptions, and these are discussed in detail in the managed health care presentations at application sites. The managed health care advocates also can assist you.
Once you get access to Medical Assistance, it can take several months to get enrolled in a health plan. In the meantime, you (and those who don't need to choose a health plan - see below) can have fee-for-service (also called straight Medical Assistance). This means you can go to any providers who accept Medical Assistance, and the provider will bill the state directly. Note: This does not apply to MinnesotaCare. Once you are enrolled in a health plan, you must get all medical care from that health plan's providers. If you go somewhere else without your health plan's approval, you will have to pay the bills. If you have questions about your health plan, call the health plan (see the phone numbers above) or call the Hennepin County Managed Health Care Office 612-596-8860.
Keeping your doctor
If each of your family members' clinics accept a different health plan, you may choose a different health plan for each person, to allow them to continue to see the same doctor. You will need to verify which plan each clinic accepts and then choose accordingly. You may change your health plan at any time during the first 12 months you are in the managed health care plan. After the first year, you can only change health plans once a year during open enrollment period which begins in September. Open enrollment changes are effective the first of January of the next year. For changes at other times, call the Managed Health Care office at 612-596-8860.
Approval for 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. Billing problems should be referred to the Managed Health Care Advocate at 612-596-8860 for investigation.
If insurance denies coverage for a certain medical service, your first step is to contact a Managed Health Care Advocate at 612-596-8860 for assistance. They will contact your doctor to determine medical necessity and negotiate with the health plan. If this does not generate satisfactory results, the advocate will direct you to the Minnesota Ombudsman's office, and you may file an appeal.
Call the Hennepin County Managed Health Care Office at 612-596-8860 for help with enrollment questions, billing questions, or complaints. They can work with you and advocate for you when you have problems with the HMO. The staff also can give presentations to individuals and groups on managed health care.