The Bureau has contracted with IMPROVE Health to resolve certain disputes involving bills for covered emergency services rendered by out-of-network medical service providers. Independent dispute resolutions apply to out-of-network bills for emergency medical services rendered on or after October 1, 2020.
Note: The IDR Process is only for emergency services claim disputes involving out-of-network providers, enrollees in a self-insured plan that has opted into Maine’s IDR process and certain uninsured consumers.
Who can request an independent dispute resolution?
- An uninsured patient
- A person covered under a self-insured/ERISA plan that has opted into Maine’s IDR process
- An out-of-network health care provider
What types of bills can I dispute?
- A bill for covered emergency services by an out-of-network provider to a person covered by a health plan.
- Bills totaling $750 or more received by an uninsured person for emergency health services for a single visit regardless of the number of providers.
How do I start a dispute?
- Fill out and submit one of the following online forms:
- Out-of-Network Medical Provider Form (one form per patient)
- Uninsured Patient Form
- Gather and submit relevant documents such as:
- Copy of bill(s)
- Claim form(s), if you have it.
- Copy of Explanation of Benefits (EOB) if you have it.
- Relevant communication between patient, provider, and/or carrier.
What happens after I submit my application?
- The Bureau will review your case to determine if it’s eligible for independent dispute resolution.
- The Bureau will forward an eligible case to Improve Health who assigns an arbitrator to the case.
- The arbitrator notifies the other party of the dispute and requests them to submit their response.
- The arbitrator requests information from the parties as needed.
When will I hear back from Improve Health about my dispute?
- The arbitrator will issue a written decision within 30 calendar days after receiving a completed application.
How much does this cost and who pays?
- In a dispute between an uninsured patient and the provider, the provider always pays.
- In a dispute between the provider and the insurance company, the losing party pays the fee or if it’s settled, the fee is divided between the parties.
For what the law says on independent dispute resolutions, click here:
http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=HP1501&item=5&snum=129 (PDF)
Carrier Form for Out-of-Network Emergency Services Provider Notice
- Independent Dispute Resolution Form (DOC) - Carriers should use this form to provide the required notice under Rule 365 § 6(1)(C):
If you have questions about the application, contact Pamela Stutch at (207) 624-8458 or by email at pamela.stutch@maine.gov.
If you have technical questions, contact research.pfr@maine.gov