Commonwealth Care Alliance

Senior Care Options Program (HMO SNP)

Members » Appeals and Grievances » Medical Care Appeals

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 reconsider — and perhaps change — this decision by making an appeal. Making an appeal means making another try to get the medical care coverage you want.

Making an appeal

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

If you would like to file an appeal, please call our Member Services team at 1-866-610-2273 (TTY 711).

You may also fax your written appeal to (617) 426-1311 or mail it to this address:

Commonwealth Care Alliance
Member Services
30 Winter Street
Boston, MA 02108

You may also utilize your MassHealth appeal rights

You may request a fair hearing from MassHealth no later than 30 calendar days from the date you received your written denial notice from Commonwealth Care Alliance. The request 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 the fair hearing request for your information.

If you do not agree with the fair hearing decision, you will have further appeal rights under MassHealth. You will be notified of those appeal rights if this happens.

Last Updated 07/29/2013