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Medical Care Appeals

What is an “appeal”?

If we say no to your request for coverage for medical care, you have the right to ask us to change our decision by filing an appeal. Filing an appeal means making another try to get the medical care coverage you want.


Filing an Appeal

You must make your appeal within 60 calendar days from the date on the written notice we send you with our answer to your request for a coverage determination. If you miss this deadline and have a good reason for missing it, we may give you more time to make your appeal.

There are three ways you, your doctor, or your appointed representative may file an appeal: 

 

Call us at 1-866-610-2273 (TTY 711).


 

Mail or fax 


Submit your written appeal to:
Commonwealth Care Alliance
Member Services
30 Winter Street
Boston, MA 02108

 

You may use your MassHealth appeal rights.


If you wish to appeal with MassHealth after having been denied by Commonwealth Care Alliance, you may do so, no later than 30 calendar days from the date you received your written appeal denial notice from us. The request for a fair hearing must contain:
  • Your name
  • Your address and phone number
  • Your MassHealth ID number or Social Security number
  • Your reason for appeal
  • If you would like your hearing to be scheduled as soon as possible
  • If you need an interpreter to be provided

If you would like to name a representative to appeal on your behalf, the request must be signed and sent via mail or fax to:

Executive Office of Health and Human Services
Board of Hearings
100 Hancock Street, 6th Floor
Quincy, MA 02171
Fax: (617) 847-1204

Please keep one copy of your MassHealth fair hearing request for your information. If you do not agree with the fair hearing decision, you will have more appeal rights under MassHealth and Medicare. You will be notified of those appeal rights.

 



 
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