Note for the Statistical Data Regarding External Review:When reviewing these statistics, it is important to note that the numbers represent the actual numbers of grievances received from members in each health plan. The membership of each plan is not taken into account in these charts. As a result, the numbers do not reflect the appeal rates per member for a particular plan and should not be used for comparison purposes. For example, a plan with 800,000 members and 70 appeals requests submitted to OPP actually has a lower rate of external appeal requests per member than a plan that has 35,000 members and 25 appeal requests. For information on the membership of each health plan licensed in Massachusetts, please go to the Division of Insurance .
- Appeal requests are categorized according to the type of service that is being requested. Listed below are the categories used by OPP and examples of the types of services that fall into each category.
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