State of Maine Health Benefits: Your Right to Appeal

There are several options available to you if you receive a denied claim.  They are:

  • You have two levels of appeal with Aetna.  You may request an appeal by contacting Aetna Member Services.  For more information about the Aetna appeals process, please refer to page 89 of your Plan Booklet (PDF).
  • You may request an independent external review from the Maine Bureau of Insurance at any time.  The Bureau can be reached by calling 1-800-300-5000.
  • Finally you also have the right to appeal to the State Employee Health Commission.  The Commission maintains an Appeals Subcommittee consisting of representatives from both Labor and Management.  An Appeal Form (MS-Word) must be completed to initiate an appeal at this level.  If the appellant is not satisfied with the decision of the Appeals Subcommittee, further appeal may be made to the full Commission.