External review in Massachusetts: deadline, cost and how to ask
Massachusetts runs its own independent review of denials: External Review (Office of Patient Protection). You generally have 4 months to ask for it.
External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.
Checked against official sources: October 30, 2026.
Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.
Step 2: Outside review in Massachusetts
- Program
External Review (Office of Patient Protection)
- Who runs it
- Health Policy Commission, Office of Patient Protection (OPP): Fully insured health plans licensed in Massachusetts, including insured employer plans
- Deadline to ask
4 months
You must send your request to OPP within 4 months of receiving the final adverse determination letter.
- The deadline runs from
The date you receive the insurer's final adverse determination letter (the letter answering your internal appeal)
- Do I have to appeal to my plan first?
Normally you must finish the insurer's internal appeal first. You can skip it if you are asking for an expedited review (you can ask for an expedited internal appeal and an expedited external review at the same time), or if the insurer did not decide your internal appeal on time.
- When you can go without a plan answer
30 days after you file your internal appeal
- How long the review takes
Standard: 45 days; Urgent: 72 hours
- Cost
You pay a $25 fee for each external review, but never more than $75 in one plan year. OPP can waive the fee for financial hardship. The $25 is refunded if the denial is reversed in full.
Source: note it on the form
- What can be reviewed
Denials based on medical necessity of a service that your plan covers when medically necessary. Services that your plan explicitly excludes are not eligible. Surprise-billing disputes under federal law can also go to external review (OPP forwards them to MAXIMUS Federal Services). Self-funded employer plans and plans licensed in another state are not eligible for OPP review.
- Is the decision final?
The decision is final and binding on you and the insurer. The superior court can enforce it.
- How to ask
Fill out the OPP Health Insurance External Review Form (online, or on paper in English or Spanish) and send it with a copy of the final adverse determination letter and any medical records or letters from your provider. Send online, by U.S. Postal Service mail with no signature required to Health Policy Commission, Office of Patient Protection, 50 Milk Street, 8th Floor, Boston, MA 02109, by fax to 617-624-5046, or in person. If OPP accepts your case, you have 10 days from OPP's letter to send more records directly to the review agency.
Law: Mass. Gen. Laws c. 176O, s. 14; Mass. Gen. Laws c. 958 CMR 3.000
- Forms and online request
- Phone
Write my appeal: free letters
Sources
The official sources for Massachusetts are listed on the Massachusetts page.