History of the Office of Patient Protection

The Office of Patient Protection is charged with developing regulations and implementing new statutory provisions of M.G.L. Chapter 176O governing managed care carriers' internal grievance procedures, detailing certain guarantees of continuity of care and specialty care referral and coverage, and establishing a process for obtaining an independent external review where coverage is denied based upon a medical necessity determination. The new legislation and regulations, 105 CMR 128.000 et.seq. may be accessed at the Department of Public Health Office of Patient Protection's website.

Effective January 1, 2001, Massachusetts consumers and other individuals who receive health coverage from a Massachusetts carrier, insurer or HMO are entitled to new protections covering internal grievances, medical necessity guidelines, continuity of care and external appeals. An insured individual who receives an adverse determination of an internal grievance has the right to an external review of a covered benefit within 45 days, and may obtain the necessary forms by calling the Department of Public Health Office of Patient Protection at 1-800-436-7757or by accessing the Department's website for copies of the form.

If you are a carrier, insurer, HMO or consumer and have questions concerning the legislation, regulations, or your rights as a managed care consumer, please contact the Department of Public Health Office of Patient Protection (OPP) at 1-800-436-7757. The managed care ombudsman will be happy to assist you. You may also contact OPP through the email.