MA Insurance grievance reports

Todd Feathers filed this request with the Health Policy Commission of Massachusetts.
Awaiting Acknowledgement


From: Todd Feathers

To Whom It May Concern:

Pursuant to the Massachusetts Public Records Law, M.G.L. c.66, ยง10, I hereby request the following records:

-- Copies of the most recent reports submitted to the Health Policy Commission by insurance carriers pursuant to M.G.L. Chapter 176O, Section 7(b). Under the law, insurance carriers must report to the HPC:

"(1) a list of sources of independently published information assessing insured satisfaction and evaluating the quality of health care services offered by the carrier;

(2) the percentage of physicians who voluntarily and involuntarily terminated participation contracts with the carrier during the previous calendar year for which such data has been compiled and the three most common reasons for voluntary and involuntary physician disenrollment;

(3) the percentage of premium revenue expended by the carrier for health care services provided to insureds for the most recent year for which information is available; and

(4) a report detailing, for the previous calendar year, the total number of; (i) filed grievances, grievances that were approved internally, grievances that were denied internally, and grievances that were withdrawn before resolution; and (ii) external appeals pursued after exhausting the internal grievance process and the resolution of all such external appeals. The report shall identify for each such category, to the extent such information is available, the demographics of such insureds, which shall include, but need not be limited to, race, gender and age."

I also ask that all fees be waived as I am a journalist employed by the Lowell Sun and I intend to use the requested records to publish articles in the public interest and not for any commercial purposes.

Thank you in advance for your anticipated cooperation in this matter. I look forward to receiving your response to this request within 10 calendar days, as the statute requires.


Todd Feathers


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