Maybe your insurance company won’t agree to cover a health care service you need. Perhaps you owe a health care bill and your health insurance company will not pay for it. What should you do?
Think about filing an appeal. In an appeal, you formally request that the insurance company review the decision. Insurance companies sometimes make mistakes or just don’t have enough information to understand your health needs. Many people who complete the appeals process win, resulting in coverage for a health care service or their medical bill paid. We have developed an Appeals Guide for people in Maine who have private health insurance plans, regulated by the Maine Bureau of Insurance or who have self-insured plans that are regulated by the U.S. Department of Labor. It explains the steps needed to challenge your health insurance company’s decision.
If you have any questions, we are here to help. Our experts can help you understand your rights, answer your questions, and guide you through your appeal. Sometimes we also represent people in their appeal. This means that we act for that person and work with their doctors and insurance company. In these cases, we can actually file the appeal for them. If you feel that you need help, call us to learn more. All calls to our HelpLine are free and confidential.
If you need help understanding a claim that has been denied or need help filing an appeal, depending on your coverage, these organizations may be able to help.
- For Marketplace, state regulated or self-insured plans, or other denials, Maine’s Health Insurance Consumer Assistance Program may be able to help. Call the Helpline at Consumers for Affordable Health Care at 1-800-965-7476.
- For help with MaineCare denials, call Consumers for Affordable Health Care at 1-800-965-7476.
- For Veteran’s Coverage or Tri-care call Maine's VA Regional Benefit Office at 1-800-827-1000.
- For Medicare find your local Area Agencies on Aging by calling 1-877-353-3771, or Legal Services for the Elderly at 1-800-750-5353.
