Massachusetts

STEP ONE – Notify Your Health Plan

The first thing you need to do is file a complaint with your health plan. By Massachusetts law, complaints must be resolved within 30 days. Follow the steps below to file a complaint and grievance with your health plan:

• The law requires health plans accept your complaint by phone, mail, in person or electronically (by fax or e-mail).
• Tell them you want to file a formal complaint and then explain the problem.
• If you disagree with your health plan’s decision, you have the right to file a grievance.
• Find more information on Massachusetts health plans’ grievance processes here.

Below are links to the complaint forms for Massachusetts’s top health plans:

• Health New England
• AllWays Health Partners
  • Contact Customer Service for more information.
• Tufts Health Plan
• UnitedHealthcare
  • Log on to MyUHC.com and complete the “Appeals and Grievance Form”
  • Select: Claims and Accounts > Medical Appeals and Grievances > Member Service Request Form
  • Fax or mail the completed form to the UnitedHealthcare address listed in the instructions
• My plan isn’t listed

STEP TWO – File a Complaint

You have the right to file a complaint with the Massachusetts Office of Patient Protection (OPP) if you have a problem getting the services you need, including quality and affordable health care. To file a complaint you must first complete your health plan’s grievance process.

• File a complaint with the OPP using the external review request form here.
• Call the OPP by phone: (800) 436-7757.