I am a MassHealth member and I got a letter saying my health plan will not cover a service my doctor ordered. Why did they deny the service?

There are many reasons why a member can receive a denial letter. For example: Maybe MassHealth or your health plan needs more information. Or maybe the service requested is not something MassHealth or your health plan usually covers. Maybe the health plan and doctor disagree about whether the service is medically necessary. Or, the reason may be something else altogether.

If you receive a letter like this, we suggest reading it carefully and holding onto it. The letter should describe the reason for your denial and the next steps you can take, like filing an appeal.  Contact your MassHealth or your health plan if you need help understanding what the letter says. If you need further assistance, you are welcome to contact My Ombudsman. We can discuss the letter together to see if we can help you understand the health plan’s decision. We can also discuss your options, including your right to ask for an appeal.