Patient Appeals and Complaints

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Despite our best efforts, patients and their families may have concerns or complaints. We encourage you to address them directly with your clinical team/practice first before seeking a more formal process, as many issues can be resolved within the clinical visit. However, if you are not able to resolve your concern at the point of care, you can address it through our complaint process.

Some complaints may be related to Boston Children’s Accountable Care Organization (ACO). ACOs are organizations consisting of a group of health care providers that work together to coordinate patient care and enter into financial agreements that reward good care delivery outcome with insurance companies. If you were directed to this information by your primary care physician, his or her practice might be a participating provider of Boston Children’s ACO and your complaint may be addressed by its appeals process. These appeals relate to one of the following areas:

  1. Timeliness of treatment or services
  2. Referrals
  3. Other concerns around limitation of care that are not due to your insurance restrictions and/or benefit plan

Complaints regarding your insurance coverage should be filed with your insurer. It is important to contact your insurer first, to understand your coverage and benefits. If you have questions about this process you can contact Dianne Arnold, MSN, RN or Elene Scheff, PT to learn more.

During the complaint process the representative will work with you or a person you choose to act on your behalf to guide you through the process. The representative will also work directly with interpreter services as well as your clinical team to address the complaint quickly. You will also receive written communication regarding your complaint within 14 days. If your complaint involves urgent medical needs, you will receive written communication within 3 days.

You may file a complaint in the following ways:

  • To file a complaint by phone – 617-919-1153

For more information or questions call 617-919-1153. For more information on your right to make a complaint, contact the Massachusetts Office of Patient Protection at 800-436-7757. This process is in compliance with Massachusetts Law that protects patients who are part of an Accountable Care Organization.

We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital 300 Longwood Avenue, Boston, MA 02115 617-355-6000 | 800-355-7944