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Managed Care Protections & Grievances
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.
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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.
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External review provides an independent review process for individuals covered by a fully insured Massachusetts health plan who have been denied benefits for reasons of medical necessity.
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