Appeals Process | Overview
A Notice to Our Patients
Boston Children's Hospital is a part of a provider organization that is certified as an “accountable care organization” (ACO) by the Massachusetts Health Policy Commission or a “risk-bearing provider organization” (RBPO) by the Massachusetts Division of Insurance. An ACO/RBPO is a group of health care providers that works together to coordinate your health care and enters into financial agreements with health insurance companies to do so. Boston Children’s Hospital is participating in an RBPO that is called Children’s Hospital Integrated Care Organization (CHICO) an ACO called Boston Children’s Accountable Care Organization (BCH ACO).
Under Massachusetts law, as a patient of an ACO/RBPO, you have the right to appeal a decision by your health care provider. CHICO and the BCH ACO will consider patient appeals about issues like referrals, timely access care, limitations on the type or intensity of care, and other concerns, unless your concern should be directed to your health insurance company instead.
You can contact a Boston Children’s Hospital Patient Relations representative to ask about this process or to file an appeal.
You can choose a person (such as a spouse, family member, friend, attorney or legal guardian) to act as your representative to help you with your appeal.
You may file an appeal by contacting a Boston Children’s Hospital Patient Relations representative in the following ways:
To file an appeal by phone: 617-919-1153
To file an appeal in writing:
Boston Children’s Hospital
Patient Relations FA111
300 Longwood Ave
Boston, Ma 02115
Fax: 617-730-1949
We will give you a written answer to your appeal in fourteen (14) calendar days. If your appeal involves an urgent medical need, we will give you a written answer in three (3) business days.
For more information or questions, call 617-919-1153. For more information on your right to file an appeal, contact the Massachusetts Office of Patient Protection via telephone at 800-436-7757, via email at hpc-opp@mass.gov, or visit the Office of Patient Protection’s website at www.mass.gov/hpc/opp.