Managed Care Frequently Asked Questions
HMO Claims and Billing

Can a network provider bill me without first billing my HMO?

No. However, the provider is allowed to bill enrollees for copayments or coinsurance called for in your contract. In addition, you may be billed for non-covered services if you agreed in advance to pay for these services.

What are "timely filing limits" and how do they affect me?

Each HMO enters into an agreement with a network of providers. The provider's contract may specify time limits for filing claims with the HMO. An enrollee cannot be held responsible for claims that a provider fails to submit to the HMO in a timely way.

How quickly should claims be paid by the health plan?

Many claims are paid electronically within a few days, but in some circumstances it requires a longer period of time. By law, a claim that contains complete and correct information, as requested by the HMO, must be paid within 30 days after it is received by the HMO. If it is not paid within 30 days, the provider may charge interest to be paid by the HMO.

I received an unexpected medical bill. What protections do I have?

If you received an unexpected bill for emergency services at an out-of-network hospital, or non-emergency services at an in-network hospital from an out-of-network provider, you may have protections under the No Surprises Act. You can find more information in the MDH No Surprises FAQ or by visiting the CMS No Surprises Act webpage.

If the conditions above don’t describe your situation, start by calling your provider’s billing office and/or your health insurance to ask about the bill. Visit MDH’s Complaint and Appeals page for information about filing a complaint about your health insurance or an appealing a decision by your health plan.

For more information, email health.mcs@state.mn.us.