Helpful Guides
- How To Appeal A MassHealth Denial – Disability Law Center
Has MassHealth denied your request for “prior-approval” for DME (durable medical equipment)? This fact sheet from the Disability Law Center can help you make your appeal. - How To Appeal An HMO Denial Of “Medical Necessity” – Office Of Patient Protection
External (independent) reviews of an HMO’s (Health Maintenance Organization’s) decision are now available through the Office of Patient Protection. External reviews are binding on the health plan. Frequently asked questions about the external review process are available for download here. - A Consumer Guide To Handling Disputes With Your Employer Or Private Health Plan – The Kaiser Family Foundation
The Kaiser Family Foundation provides this useful guide for how to pursue “internal reviews” (the health plan’s own grievance process) as well as “external reviews” (an independent appeals process) of your private health insurance claim denial. The guide also helps explain health insurance coverage and relevant state and federal laws.
For more on appealing denials by health plan type, see the Medically Necessary AT funding guide.
Organizations
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Disability Law Center – Massachusetts
The DLC provides advocacy, information, or referral for requests for disability related advocacy.
In the Boston area call:
Phone: (617) 723-8455/(800) 872-9992
TTY: (617) 227-9464/(800) 381-0577
In western Massachusetts:
Phone: (413) 584-6337 / (800) 222-5619
TTY: (413) 582-6919
Massachusetts Legal Assistance Corporation (MLAC)
MLAC provides legal services to low-income people (up to 125% of the federal poverty level) throughout Massachusetts. Programs include the Medicare Advocacy Project (MAP) for low-income people improperly denied Medicare coverage, and the Disability Benefits Project (DBP) for low-income people with disabilities who have been improperly denied federal SSI or SSDI benefits. Additional service areas include General Support (family law, housing, income maintenance, health care access, consumer problems), and the Battered Women’s Legal Assistance Project.
For more information:
11 Beacon St., Suite 820 (Map)
Boston, MA, 02108 US
Voice: (617) 367-8544
Fax: (617) 367-8815
Mass Legal Help website
Legal aid programs are also available by region:
Eastern Massachusetts
Greater Boston Legal Services (MLAC) (Map)
197 Friend Street
Boston, MA, 02114 US
Voice: (617) 371-1234/(800) 323-3205
Fax: (617) 371-1222
TTY: (617) 371-1228
http://www.gbls.org
Boston College Legal Assistance Bureau (Map)
24 Crescent Street, Suite 202
Waltham, MA, 02453-4088 US
Voice: (781) 893-4793
Fax: (781) 893-4799
Community Legal Services & Counseling Center (Map)
One West Street
Cambridge, MA, 02139 US
Voice: (617) 661-1010
Fax: (617) 661-3289
http://www.clsacc.org
South Middlesex Legal Services (Map)
54 Waverly Street
Framingham, MA, 01702 US
Voice: (508) 620-1830
Fax: (508) 620-2323
http://www.ncla.net
Volunteer Lawyers Project (LSC) (Map)
29 Temple Place, Suite 300
Boston, MA, 02111 US
Voice: (617) 423-0648
Fax: (617) 423-0061
http://www.vlpnet.org/
Central and Western Region:
Legal Assistance Corporation Of Central Massachusetts (MLAC) (Map)
405 Main Street, 4th Floor
Worcester, MA, 01608 US
Voice: (508) 752-3722
Fax: (508) 752-5918
http://www.livejustice.org
Western Massachusetts Legal Services (MLAC) (Map)
127 State Street, 4th Floor
Springfield, MA, 01103-1944 US
Voice: (413) 781-7814
Fax: (413) 746-3221
http://www.wmls.org
Massachusetts Justice Project (LSC) (Map)
57 Suffolk Street, Suite 401
Holyoke, MA, 01040 US
Voice: (413) 533-2660/(800) 639-1209
Fax: (413) 535-1774
TTY: (413) 533-2660
http://www.neighborhoodlaw.org
Northeast Region:
Neighborhood Legal Services (MLAC) (Map)
37 Friend Street
Lynn, MA, 01902 US
Voice: (781) 599-7730
Fax: (781) 595-2022
http://www.neighborhoodlaw.org
Childrens Law Center Of Massachusetts (Map)
P.O. Box 710
Lynn, MA, 01903 US
Voice: (781) 581-1977
Fax: (781) 598-9364
http://www.ncla.net
Merrimack Valley-North Shore Legal Services (LSC) (Map)
35 John Street, Suite 302
Lowell, MA, 01852 US
Voice: (978) 458-1465
Fax: (978) 458-3481
http://www.mvlegal.org
Southeast Region:
South Coastal Counties Legal Services (MLAC)
P.O. Box 2507
Fall River, MA, 02722-2507 US
Voice: (508) 676-5022
Fax: (508) 676-8657
http://www.lscci.org
New Center For Legal Advocacy (LSC) (Map)
257 Union Street
New Bedford, MA, 02740 US
Voice: (800) 244-9023
http://www.ncla.net
Mental Health Legal Advisors Committee (MHLAC)
MHLAC provides advocacy and referral services for individuals navigating the state mental health system, as well as those seeking insurance coverage for mental health services. Their managed care hotline (1-888-266-2555) offers legal advice to people facing challenges such as being denied mental health services by their managed care provider, struggling to get their insurance company to cover mental health treatment, having their services cut off prematurely, or being dissatisfied with the quality of care they received. Calls are typically returned within two business days.
399 Washington Street, 4th floor
Boston, MA, 02108
Email: MHLAC@mhlac.org
www.mass.gov/mhlac
Office of Patient Protection (OPP) – Massachusetts Department of Public Health (MDPH)
The Office of Patient Protection serves as a “managed care ombudsman,” offering guidance to managed care consumers, carriers, and insurers. OPP helps individuals appeal HMO (Health Maintenance Organization) decisions through an independent “external review” process. Established under Chapter 141 of the Acts of 2000—one of the strongest HMO regulations in the country—OPP ensures that anyone with health insurance from a Massachusetts carrier, insurer, or HMO is entitled to protections regarding internal grievances, medical necessity guidelines, continuity of care, and independent external reviews. However, the law does not apply to self-funded employer health plans, Medicare, Medicaid, or federal employee plans. Consumers, insurers, and carriers with questions about regulations, legal protections, or consumer rights can contact OPP at 1-800-436-7757.