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Confused about your coverage?

Coverage Denials and Appeals

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. Insurance companies sometimes make mistakes or just don’t have enough information to understand your health needs. In an appeal, you formally request that the insurance company review the decision. Filing an appeal can be worth it. About half of the people who complete the appeals process win,  resulting in coverage for a health care service or their medical bill paid.

If you have any questions, call us. We 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, different organizations are ready to help.

  • For Marketplace, MaineCare, or other denials call Consumers for Affordable Health Care at 1-800-965-7476
  • For Veteran’s Coverage or Tricare call the 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

We have developed an Appeals Guide for people in Maine who have private health insurance plans. It explains the steps needed to challenge your health insurance company’s decision. Call us for assistance.