To: External Review Agencies under Contract with the Department of Public Health Pursuant to M.G.L. c. 176O, § 14
cc: Commercial Health Insurers, Blue Cross Blue Shield of Massachusetts, and Health Maintenance Organizations Accredited Pursuant to M.G.L. c. 176O
From: Carol Balulescu, Director, Office of Patient Protection
Re: External Review Decisions of Services Deemed to be Experimental/Investigational
Date: April 1, 2008
The Office of Patient Protection (OPP) would like to clarify its expectations regarding the process of external review of services that a health plan has deemed to be investigational or experimental.
As noted in the advisory memo that OPP issued on December 11, 2002, OPP expects the following of external review agencies: