How to file a HSN grievance

If you are a patient, you may request that the HSN

• conduct a review of an eligibility determination, or
• conduct a review of provider compliance with the Health Safety Net regulation.

To file a HSN grievance, send a letter to

Health Safety Net
Attn: HSN Grievances
100 Hancock Street, 6th floor
Quincy, MA 02171

At a minimum, the letter should include your name and address. If possible, it should also include

• information about the situation
• the reason for the grievance
• the provider's name (if a provider is involved), and
• any other relevant information.

The more information you give, the better. Make sure to include the provider's name if a provider is involved.

You can find more information about this in the Health Safety Net Eligible Services regulation (101 CMR 613.00 in section 613.04(3)). Questions about filing a grievance should be directed to the HSN Help Line at (877) 910-2100.