Who should I call if I have any questions about filing a complaint?

You can contact the Bureau at (800) 300-5000 or (207) 624-8475. The Bureau is open from 8:00 a.m. to 5:00 p.m., Monday through Friday.

What happens after the Bureau receives my complaint?

Your complaint will be assigned to a claims investigator. The investigator will contact your insurer and request a response. The health insurer has 14 days to respond, but may request an extension. It usually takes a minimum of 30 days...

How do I file a complaint?

If you are a Maine resident, you can file a complaint with the Bureau at any time during the appeals process. Your complaint should include the following information: The name, address, email address, and telephone number of the person filing...

How long will the external review process take?

The external review process should take no more than 30 days from the date the external review organization receives the request.[19] If you request an expedited external review, the process should take no longer than four business days after your request...

How do I request an external review?

You should call or write to the Maine Bureau of Insurance (“Bureau”) to request an external review within 12 months from the date that your insurer denied the second level internal appeal.[14] You can reach the Bureau at (207) 624-7475 or...

What if my insurer denies my coverage after a second level internal appeal?

If your insurer denies your coverage after completing the first and second level internal appeals processes, you are entitled by law to request an external review from an independent third party. This means your insurer no longer has the final...

How long should the internal appeals process take?

The first level internal appeals process should take a maximum of 30 days from the date your insurance company receives your request for an internal appeal.[9] If you request a hearing during the second level appeal, your health insurer must schedule...

How do I submit a second level internal appeal?

If the first level internal appeal is not successful, you should submit a request to your health insurer for a second level internal appeal. During the second level internal appeal, your case is reviewed by a panel of insurance company...

How do I request a first level internal appeal?

If your insurer denies your claim, you have the right to a first level internal appeal. This means you can ask your insurer to conduct a full and fair review of its decision. To appeal the denial, you should do...

How do I request reconsideration of my denial?

If your insurer denies your claim for a medical reason, then your health care provider may request a reconsideration of the denial. You are not responsible for submitting the request. The request must be completed by your insurer within one...

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