Can I appeal an adverse MassHealth decision?

On Behalf of | Sep 22, 2022 | MassHealth

If you are applying for MassHealth and your application is denied, or if you currently are a MassHealth member and a prior authorization was changed or denied, it is easy to feel discouraged. But do not give up. It is possible to appeal an adverse MassHealth decision.

The MassHealth appeals process

The first step in the MassHealth appeals process is to complete a Fair Hearing Request form. You have 120 days to do this following the adverse decision. The form can be submitted via U.S. post, fax or online.

After you submit your Fair Hearing Request form, the Board of Hearings will set a hearing date. You will receive written notification of this date, time and where the hearing will take place. You will receive this notice 10 calendar days or more before the date your hearing is to take place. If you are unable to attend an in-person hearing, a telephone hearing may be scheduled.

You have the right to an attorney of your choosing at your hearing. This representation is at your own expense, although there are pro bono organizations and attorneys that provide these services.

If you do not attend your hearing without good cause, your appeal may be dismissed.

You do not have to proceed with your appeal alone

While it may seem simple enough to appeal an adverse MassHealth appeal, it is generally not recommended to proceed with your appeal without assistance. MassHealth is a complex organization, and it is easy for a seemingly simple complaint to become very complex very quickly. You are not expected to know how to appeal alone. Professional help can be beneficial in securing the result from an appeal that you need.