This page, How to request an external review of a health insurance decision with the Office of Patient Protection (OPP), is part of
This page, How to request an external review of a health insurance decision with the Office of Patient Protection (OPP), is offered by

How to request an external review of a health insurance decision with the Office of Patient Protection (OPP)

If your health insurance company denies your internal appeal, you may request an external review by following these steps.
You must submit your external review request within 4 months of being notified by your health insurance company that your internal appeal was denied.

Office of Patient Protection

Phone

Don’t speak English? We can still help. An interpreter will help translate the conversation.

The Details of How to request an external review of a health insurance decision with the Office of Patient Protection (OPP)

What you need for How to request an external review of a health insurance decision with the Office of Patient Protection (OPP)

Fees for How to request an external review of a health insurance decision with the Office of Patient Protection (OPP)

Fee is waived in cases of financial hardship. 

Name Fee Unit
External Review Request $25 per external review ($75 max/year)

How to request How to request an external review of a health insurance decision with the Office of Patient Protection (OPP)

Please note: At this time OPP may accept mail only through United States Postal Service with no signature of receipt required. Correspondence mailed that requires a signature or uses other delivery services will be returned to sender.

Please mail your completed request form to:

Health Policy Commission
Office of Patient Protection
50 Milk Street, 8th Floor
Boston, MA 02109

You may also submit your completed request form in-person at the address above.

You may also fax your completed request form to 617-624-5046.

OPP cannot accept external review request forms by email. Do not send personal health information or other confidential information to OPP by email.

Next steps for How to request an external review of a health insurance decision with the Office of Patient Protection (OPP)

  1. Obtain a copy of your final adverse determination letter from your health insurance company and gather relevant medical records

  2. Complete all necessary pages of the OPP external review request form (if you are requesting an expedited external review, you must complete additional pages)

  3. Submit your external review request form to OPP within 4 months of receiving your final adverse determination letter

More info for How to request an external review of a health insurance decision with the Office of Patient Protection (OPP)

See here for frequently asked questions (FAQs) about the external review process.

What happens after I submit my external review request form?

You will either receive a letter from OPP stating that your request is eligible for external review or you will receive a letter from OPP stating that your request is ineligible and the reason why it is ineligible.

If your request is eligible, the letter will notify you which external review agency is handling your request. If you want to provide additional documentation or medical records for your appeal, you must send those records to the external review agency directly within 10 days of OPP’s letter. If you have additional information to submit on an expedited external review request, please call OPP.

Contact for How to request an external review of a health insurance decision with the Office of Patient Protection (OPP)

Address
Massachusetts Health Policy Commission - Office of Patient Protection
50 Milk Street, 8th Floor, Boston, MA 02109
Phone

Don’t speak English? We can still help. An interpreter will help translate the conversation.

Fax
1-617-624-5046
Feedback