Perhaps you owe a health care bill and your health insurance company says they will not pay for it. Or maybe your insurance company won’t agree to cover a health care service you need. What do you do?
Think about asking for an appeal. Insurance companies sometimes make mistakes or just don’t have enough information to understand your health needs. About half of people who complete the appeals process win and have their medical bills paid. Filing an appeal can be worth it.
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.
If you have been denied by a public plan, like the ones listed below, your appeal will be different than what we talk about in the Appeals Guide. You can find out about your appeal rights by calling our Consumer Assistance HelpLine at 1-800-965-7476, or the groups listed below:
- MaineCare or Medicaid: Maine Equal Justice Partners, 1-866-626-7059
- Veteran’s Coverage or Tricare: VA Regional Benefit Office, 1-800-827-1000
- Medicare: Area Agencies on Aging, 1-877-353-3771, or Legal Services for the Elderly, 1-800-750-5353
If you have any questions about this Guide or the appeal steps, call our Consumer Assistance HelpLine. 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. Our Consumer Assistance HelpLine number is 1-800-965-7476. All calls to our HelpLine are free and confidential.