Patient Appeals and Complaints

CHICO ACO Patient Appeals Program

You may have heard about the ACO Patient Appeals program from your doctor or from a letter, you received in the mail from Boston Children’s Hospital. The Appeals program is a way to file your ACO related grievance.

Your doctor is part of a group of primary care offices that work with Boston Children’s Hospital to improve healthcare and help patients access more services, programs and resources within an Accountable Care Organization (ACO) called the Children’s Hospital Integrated Care Organization (CHICO). ACOs are part of federal and state healthcare laws. Appeals or grievances are complaints you might have about timeliness of care or access to care in the ACO.

This program will not change your primary care doctor, access to Boston Children’s Hospital, access to other doctors outside of Boston Children’s Hospital, nor your insurance coverage. All of your care will remain the same. 

If you have a grievance that you do not feel comfortable talking about with your doctor, we recommend calling the Appeals line. Some examples of grievance related to ACOs include:

  • Timeliness of treatment or services
  • Requests for referrals that you do not receive
  • Ability to get the care you think you/your child needs

You should continue to contact your insurer if you have a grievance regarding your insurance coverage. It is important to contact your insurer first, to understand your coverage and benefits.

If you do not know if your issue is an ACO grievance, you can visit our FAQ page or call the ACO Appeals line and a representative will explain the program. You can also call MassHealth or the office of Patient Protections in the Health Policy Commission at any time and at any point in the process to decide what steps you should take.

MassHealth: 1-800-841-2900 or TTY 1-800-497-4648

Massachusetts Office of Patient Protection: 800-436-7757

How to file a grievance, ACO Appeals Line: Call 617-919-1153

Once you call the ACO Appeals line a representative will answer your call and collect basic information about the patient and the issue. You or someone acting on your behalf can call the ACO Appeals line. The representative will also work directly with interpreter services as well as your clinical team to address the grievance quickly.

We will respond to you in two (2) business days to let you know we received your grievance. We will give you a written answer to your grievance in thirty (30) calendar days. If your grievance involves urgent medical needs, we will give you a written answer in three (3) business days.

You can get this information in Spanish, or speak with someone about this information in other languages for free. Call 617-355-6279.

Puede obtener esta información en español, o hablar con alguien acerca de esta información en otros idiomas de forma gratuita. Llame al 617-355-6279.