Office of Patient Protection
Welcome to the Office of Patient Protection in the Department of Public Health. The Office of Patient Protection (OPP) was established to help consumers who are enrolled in a Massachusetts managed care plan and have questions or problems obtaining covered services. The Office of Patient Protection helps consumers in two ways:
- Our staff can help you navigate the managed care requirements of your health insurer and help you appeal if your health insurer has denied a claim or access to services. Please read our “Frequently Asked Questions” for information about the Massachusetts laws that your health insurer must follow.
- If you have gone through the internal appeal process with your insurer and the answer is still "no", OPP administers an external appeal process for an independent medical review of your case. Additional information and the form to request an external review is on the External Review Process page.
Quick Links
- History of the Office of Patient Protection
- Frequently Asked Questions
- External Review Process
- Statistics and Reports
- Managed Care Statutes and Regulations
- Bulletins and Memoranda from the Office of Patient Protection and the Division of Insurance
- Managed Care Consumer Guide
- Helpful Links
Contact Information
If you are insured through a Massachusetts health plan and have questions about your rights as a managed care consumer, please call the Office of Patient Protection at 1-800-436-7757 or email us.
If you have a health insurance problem that is not within OPP’s jurisdiction, we will refer you to the appropriate state or federal agency for additional help. Common referral numbers appear below.
PLEASE NOTE THAT OPP HAS NO AUTHORITY OVER MASSHEALTH (MEDICAID) OR MEDICARE. IF YOU NEED HELP WITH MASSHEALTH OR MEDICARE PLEASE CALL THE NUMBERS BELOW.
Division of Medical Assistance (MassHealth/Medicaid) 1-800-841-2900
Medicare Hotline 1-800-638-6833
Other agencies that provide health insurance consumer assistance:
- Attorney General's Insurance Hotline 1-888-830-6277
- Commonwealth Care 1-877-623-6765 (enrollment and eligibility)
- Division of Insurance Consumer Hotline 1-617-521-7777 (health insurers licensed in Massachusetts)
- Federal Office of Employee Benefits Security Administration 1-866-444-3272 (Employer self-funded health plans and federal Department of Labor rules)
- Executive Office of Elder Affairs 1-800-243-4636
If you have a question or complaint about a Massachusetts hospital or nursing home, please call the Division of Health Care Quality at 1-800-462-5540. If you have a question or complaint about a physician, please call the Board of Registration in Medicine at 1-800-377-0550.
This information is provided by the Office of Patient Protection within the Department of Public Health.