Your Right to Appeal

There are options available to you if you receive a denied claim (adverse health care treatment decisions).  They are:

  • You have two levels of appeal with Anthem Blue Cross and Blue Shield and Express Scripts.  You may request an appeal by contacting Member Services. 
  • 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.

Members may appeal to the State Employee Health Commission ("SEHC") for denials of the health premium credit or any final decision by the State's health or pharmacy benefit carrier unrelated to adverse health care treatment decisions. Please note: Appeals to the SEHC are conducted in public. A member must waive their right to confidentiality of personal health information if they intend to discuss it during the course of the appeal hearing. Members must consider this before disclosing personal health information to the Commission's appeals committee members.