Who should I call if I have any questions about filing a complaint?

You can contact the Massachusetts Division of Insurance at (617) 521-7794 or (877) 563-4467. The Division is open from 8:45 a.m. to 5:00 p.m., Monday through Friday.

What happens after the Division receives my complaint?

The Division will provide a copy of your complaint to your health insurer and attempt to resolve the issue. The Division may negotiate a settlement or hold an administrative hearing.[24] If the Division determines that your health insurer has violated a...

How do I file a complaint?

If you are a Massachusetts resident and your insurer still denies your claim after the external review process, you can file a complaint with the Massachusetts Division of Insurance (“Division”). Complaint information. You can find the complaint form here. Your complaint should...

How long will the external review process take?

The external review process should take no more than 45 days from the date the external review agency receives the request. If you request an expedited external review, the process should take no longer than 72 hours after your request...

How do I request an external review?

You must file your request for an external review with the Massachusetts Office of Patient Protection (“Office”) within four months of the date on your insurer’s most recent decision. Information. You can find a copy of the external review request form here.[14] You...

In what circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[11] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under Massachusetts law, you are entitled to request an external...

How long should the grievance process take?

The grievance process should take a maximum of 30 business days, regardless of how many internal levels of review your health insurer requires.[7] An expedited grievance review should take no longer than 48 hours once your physician certifies that there...

How do I file a grievance?

If your insurer denies your claim, you have the right to file a grievance with your health insurer.[1] This means you can ask your insurer to conduct a full and fair review of its decision. To file a grievance, you should...

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