Your appeal
The insurance company on your card
Sanford Health Plan
Send it to the appeal address printed on your denial letter (or the back of your card). Appeals go to the insurer, not your employer.
Health plan & appeal guide
Human Service Agency
Insured · state rules
Human Service Agency Health Benefits Plan · 164 people
An insurance company pays the claims, so your state’s insurance rules apply and your state can help overrule a wrong denial.
How we know · high confidence
- Medical insurance bought from Sanford Health Plan is on file, covering about 181 people.
- The filing says all benefits are paid through insurance contracts.
Double-check in 30 seconds: “Self-funded”, “administered by” or “ASO” on your card or plan summary means self-funded. “Insured by” or “underwritten by” means insured.
Send your appeal here
Plan documents
The plan administrator
HUMAN SERVICE AGENCY
ATTN: PLAN ADMINISTRATOR
123 19TH STREET N.E.
PO BOX 1030
WATERTOWN, SD 57201Ask in writing for the Summary Plan Description and the insurance certificate. Employer plans must send them within 30 days.
Know your deadlines
- Internal appeal to the insurance company180 days from the denial
- Independent external review4 months from the final denial
Dates you enter stay on this device.
What happens next
File in writing within 180 days of the denial notice. Ask for your complete claim file and the criteria they used. They must give it to you free. They decide within 30 days for care you haven't had yet, 60 days for care you already received.
If they say no again, request external review within 4 months of that final denial. It is run by the state where the policy was issued, usually your employer's home state (SD). The review is usually free. A reviewer outside the plan decides, usually within 45 days, and the plan must follow the decision.
If waiting could seriously harm your health, say so in writing. The plan must decide within 72 hours, and you can ask for expedited external review at the same time.
Get free help
External review covers denials based on medical judgment ("not medically necessary", "experimental"), cancelled coverage, and surprise-billing disputes. A flat plan exclusion usually isn't eligible, but you can still file the internal appeal.
If your plan documents say the plan is "grandfathered" (unchanged since March 2010), the external-review rules may not apply.
Coming next
Get help writing the appeal letter
We’re building a tool that drafts your appeal from the denial letter and keeps track of every deadline. Leave your email and we’ll send one note when it’s ready.