Consumers 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 independent external reviews.
Chapter 224 of the Acts of 2012 transferred the Office of Patient Protection to the Health Policy Commission from its former home at the Department of Public Health. This transfer became effective on April 20, 2013.
Beginning on April 20, 2013, requests for external reviews of health insurance coverage decisions, and requests for waivers to purchase insurance outside of the open enrollment periods, should be sent to the Office of Patient Protection at the Health Policy Commission. Use this contact information to reach the Office of Patient Protection at the Health Policy Commission:
Health Policy Commission
Office of Patient Protection
Two Boylston Street, 6th Floor
Boston, MA 02116
As of April 20, 2013, please use the new Health Policy Commission forms to request external review or an open enrollment waiver.
Questions about the OPP Transfer?
- You can contact the Health Policy Commission at 617-979-1400. You can also contact us by email at HPC-OPP@state.ma.us, but we cannot accept external review requests, open enrollment waiver requests, or any personal health information by email.
- Notice of Transfer (March 20, 2013)
- Updated information about implementation of Chapter 224 can be found here: www.mass.gov/governor/agenda/healthcare/cost-containment/
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.
- Health Insurance Open Enrollment and Waivers
- 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
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 law created the Office of Patient Protection within the Department of Public Health, and added chapter 176O, Health Insurance Consumer Protections, to the Massachusetts General Laws.