Maine: Start Here
Beginner guide for Maine—CoverME.gov Marketplace, Bureau external review, PA deadlines, and what to open next.
Read guideState playbook
Maine
State insurers, legislation, and appeal resources for patients and advocates in Maine.
4 guides
Maine Prior Authorization Law
24-A §4304—72-hour/2-day PA, deemed approved if late, emergency and MAT protections, Rx electronic standards.
Read guideMaine Health Insurance Appeals and Grievances
24-A §4303—grievance procedure, 30-day decisions, exhaustion rules, path to Bureau §4312 review.
Read guideMaine External Review (Bureau / IRO)
Binding IRO review—12-month filing with Bureau, 30-day standard, 72-hour expedited, 24-A §4312.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- Anthem Health Plans of Maine
- Harvard Pilgrim Health Care
- Community Health Options
- Taro Health
- CoverME.gov (Maine Marketplace)
- MaineCare / DHHS
External appeals
After internal appeal, for eligible Maine fully insured plans only.
- Bureau of Insurance — External Review
- MaineCare — Fair hearing