By state / Massachusetts

Massachusetts

Regulator

Massachusetts Office of Patient Protection (OPP) at Health Policy Commission

External review

State-run. Request it through the regulator after the plan's final internal denial; the federal floor is 4 months (45 CFR 147.136).

Published reversal rate

0.4% of reviews reversed the plan (2023) · source

Notes

~40% of OPP external reviews resolved in patient's favor per OPP 2023 Annual Report referenced by MA HPC. 2024 report not yet located; flag as most-recent-published is 2023.

Before external review

File the plan's internal appeal first (at least 180 days for ACA-compliant plans; the letter states the date). Ask for the claim file and the criteria the plan applied; both are free on request. Self-funded employer plans use the federal external review and the U.S. Department of Labor, not the state.

More on Massachusetts: state appeal rights · External Review Index entry · insurer denial rates (HealthCare.gov states).

Verified 2026-09-15. The regulator's site and your denial notice control.