External review in Maine: deadline, cost and how to ask
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.
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.
Step 2: Outside review in Maine
- Program
Independent External Review
- Who runs it
- Maine Bureau of Insurance, which assigns an independent external review organization: Fully insured health plans regulated by Maine, including insured employer plans
- Deadline to ask
12 months
You must make a written request to the Bureau of Insurance within 12 months of receiving the final internal appeal decision.
- The deadline runs from
The date you received the insurer's final adverse decision under its internal grievance process
- Do I have to appeal to my plan first?
With a group (employer) plan you must finish all levels of the insurer's internal appeal (usually two). With an individual plan you need to finish only one level. You do not have to finish the internal appeals if the insurer missed its deadline or did not follow the appeal rules, if you ask for expedited external review at the same time as an expedited internal appeal, if you and the insurer agree to skip it, if your life or health is in serious jeopardy, if the person has died, or if the denial concerns care while you are still in the facility after emergency services.
- How long the review takes
Standard: 30 days; Urgent: 72 hours
- Cost
There is no filing fee. The insurer pays the cost of the review. Your only costs are things like postage or time off to attend the phone hearing.
- What can be reviewed
Adverse health care treatment decisions, such as medical necessity, pre-existing conditions, experimental or investigational treatment, and medical diagnosis, care or treatment. If your policy clearly does not cover the service, it does not qualify. Not having prior authorization does not by itself stop you from asking for external review. MaineCare, Medicare, CHIP and plans not regulated by the State are not eligible.
- Is the decision final?
The decision is binding on the insurer. You cannot ask for a second external review of the same decision. You keep any other legal rights, including going to court.
- How to ask
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.
Law: 24-A M.R.S. 4312
- Forms and online request
- Phone
Write my appeal: free letters
Sources
The official sources for Maine are listed on the Maine page.