Health insurance or Medicaid said no in Maine? Deadlines and free help

In Maine, your health plan is regulated by Maine Bureau of Insurance (Department of Professional and Financial Regulation), if it is a state-regulated plan.

Maine runs its own independent review of denials: Independent External Review. You generally have 12 months to ask for it.

External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.

Pick your plan type

Which kind of coverage was denied? The plan type decides which rules and deadlines apply.

Insurance I bought or got through work

Your state insurance rules may apply. First appeal to your plan, then ask for an outside review.

My employer pays claims itself (self-funded)

Federal rules apply, and most state insurance laws do not. Free help comes from the U.S. Department of Labor.

Medicaid / MaineCare

You ask the state for a fair hearing. In a Medicaid health plan, you usually appeal to the plan first.

Marketplace (CoverME.gov) decision

A decision about whether you can buy a plan or get financial help is appealed to the Marketplace.

How long do I have?Urgent care: faster decisionWrite my appealFree help

Checked against official sources: October 30, 2026.

Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.

How long do I have in Maine?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
12 months
Hearing deadline
60 days
Appeal deadline – CoverME.gov
90 days

All the details →

How long do I have? Deadline calculator

How do I know which plan type I have?

How to tell which agency regulates your plan

To use Maine's external review, your coverage must be a fully funded (true insurance) plan, not a self-funded plan paid for by your employer (usually large employers). Ask your insurance company or your employer's human resources department. Some trusts are self-funded but still qualify.

Step 1: Appeal to your plan in Maine

What it is called: Grievance (first level and second level appeal)

Maine gives you two levels of internal appeal. The insurer has 30 days to decide a first level appeal. At the second level, a panel reviews your case and you can ask for a hearing, in person or by phone; the insurer must hold it within 45 days and decide within 5 working days after it, or decide within 30 calendar days if there is no hearing. If your life, health or ability to function is in serious jeopardy, you can ask for an expedited appeal, decided within 72 hours (not for care already received). If a medical opinion is a material issue, you are entitled to an independent second opinion from a provider of the same specialty, paid for by the plan. The plan may not reduce or end benefits for an ongoing course of treatment, including a prescription drug, while your appeal or external review is going on.

Law: 24-A M.R.S. 4303(4)

All the details →

Step 2: Outside review in Maine

Independent External Review

Deadline to ask: 12 months.

All the details →

Urgent care in Maine: faster decisions

Outside review

If waiting 30 days would seriously jeopardize your life or health or your ability to regain maximum function, the decision must be made as fast as your condition requires and no later than 72 hours after the complete request is received.

Law: 24-A M.R.S. 4312

Standard: 30 days; Urgent: 72 hours

Marketplace

You can check the box on the form to ask for an expedited review.

Complaints about your plan in Maine

You can file a complaint with the Bureau of Insurance at any time, using its Life and Health complaint form. A complaint investigation and your appeals are separate and can happen at the same time; the Bureau will monitor whether the insurer is handling your appeals properly.

www.maine.gov

Medicaid (MaineCare) denials in Maine

Who holds the hearing: Maine DHHS Division of Administrative Hearings (impartial hearing officer); the MaineCare Hearings Coordinator takes requests about MaineCare service decisions.

Hearing deadline: 60 days

All the details →

Marketplace decisions in Maine

Marketplace

CoverME.gov · 1-866-636-0355

Appeal deadline

90 days

The date of your CoverME.gov Eligibility Notice

How to appeal

Fill out the Maine Eligibility Appeals Request Form and mail it to CoverME.gov Consumer Assistance Center, P.O. Box 616, Augusta, ME 04332-6626. You can appeal a special enrollment period denial, a denial of eligibility to buy a plan, or a denial or wrong amount of premium tax credits or cost-sharing reductions. Problems with your plan paying a claim are not Marketplace appeals.

Form

Maine Eligibility Appeals Request Form

Faster appeal

You can check the box on the form to ask for an expedited review.

Coverage while you appeal

You can ask on the form to keep receiving premium tax credits and cost-sharing reductions while your appeal is pending. If you lose, you may owe more federal tax or get a smaller refund.

Other rights in Maine

Ongoing treatment continues during appeals

A health plan may not reduce or end benefits for an ongoing course of treatment, including a prescription drug, while an internal appeal or an independent external review is pending.

Free independent second opinion

In an appeal where a professional medical opinion about a health condition is a material issue, you are entitled to an independent second opinion from a provider of the same specialty, paid for by the plan.

Law: 24-A M.R.S. 4303(4)

You can take part in the external review

In Maine's external review you have the right to attend (usually by phone), submit and obtain evidence, ask questions of the insurer's representative and have outside help.

Law: 24-A M.R.S. 4312(3)(C), (5)(B)

Prior authorization time limits

An insurer must answer a provider's prior authorization request for a nonemergency service within 72 hours or 2 business days, whichever is less (the same limit applies after it receives requested information). If it does not grant or deny the request in time, the request is granted. Once prior approval is granted, the insurer may not later deny payment for that service unless the information given was fraudulent or materially incorrect.

Law: 24-A M.R.S. 4304(1), (2)

How long do I have? Deadline calculator

Pick your plan type and enter the dates on your notice. We count from the rules in Maine and the federal rules.

Worked out in your browser. Nothing you enter here is saved or sent.

If you are not sure when it arrived, use the date printed on the notice. That date is never later than the day it arrived.

Choose what was decided and enter the date on your notice

We add the number of days or months from the law to your date. Nothing is saved.

Write my appeal: free letters

Free help in Maine

Good to know in Maine

  • Maine gives you 12 months after the final internal denial to request an independent external review, much longer than the federal 4 months.
  • With an individual plan in Maine you need to finish only one level of internal appeal before external review; with a group plan, all levels.

    Law: 24-A M.R.S. 4312(1)

  • MaineCare members have 60 days from the date of the letter to ask for a Fair Hearing.

Changes in 2024–2026

PL 2023, c. 680 (2024) added rules letting an enrollee's authorized representative, including a treating provider, file a grievance or external review request, with written notice to the enrollee at least 14 days before filing and within 7 days after. PL 2025, c. 348 amended 4312(6).

Law: 24-A M.R.S. 4303(4), 4312(1-A)

Questions about appeals in Maine

How long do I have to appeal a health insurance denial in Maine?

Most insurers ask you to file your first level appeal in writing within 180 days of the denial. The denial notice must tell you the time limit. You have at least 180 days (about 6 months) from when you receive the denial notice to file an internal appeal.

How do I get an outside (external) review in Maine?

Independent External Review. Send a written request to the Maine Bureau of Insurance, 34 State House Station, Augusta, ME 04333, with the Bureau's contact sheet (needed if you want to take part in the phone hearing), the signed authorization to release records, and a copy of the insurer's final appeal denial. You have the right to attend the review (usually a phone hearing of about an hour), present information, ask questions of the insurer's representative and bring your own doctor or outside help.

Is outside review free in Maine?

There is no filing fee. The insurer pays the cost of the review.

How long do I have to ask for a Medicaid fair hearing in Maine?

60 days. The date of the MaineCare letter (decisions to deny, reduce or end covered services)

Can I keep my Medicaid benefits while I appeal in Maine?

If you ask for a Fair Hearing within 10 days of the date on the letter, your current services continue until a decision is made. If you lose, you may have to repay the cost of services received while the appeal was pending.

How do I appeal a Marketplace decision in Maine?

Fill out the Maine Eligibility Appeals Request Form and mail it to CoverME.gov Consumer Assistance Center, P.O. Box 616, Augusta, ME 04332-6626. You can appeal a special enrollment period denial, a denial of eligibility to buy a plan, or a denial or wrong amount of premium tax credits or cost-sharing reductions.

Not about a denied claim?

Nearby states

Sources

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