Before and After Purchasing Health Insurance in Maine

When it comes to purchasing health insurance in Maine, it is always recommended for consumers to shop around before making any decisions. This is because there are numerous policies available at different premium rates and it is imperative to find one that will meet the health care needs of the consumer without being too costly.

In shopping around, consumers should evaluate a potential insurance provider based on several factor. One would be on the efficiency of its customer service. Consumers should determine how well the staff or agents of a particular insurance company treat potential customers and to determine if they answer all questions accurately and thoroughly. Consumers should stay away from insurance agents and brokers who make pressuring tactics just to make a sale. It would not also hurt to ask around regarding post-sales customer service of an insurance company as consumers would typically have questions and complaints regarding the health insurance policy after they made the purchase. Consumers should only deal with insurance providers that are duly licensed by the Maine Bureau of Insurance and are financially stable enough to pay for any claims made in the future. Of course, cost is also a major consideration, as different policies with different premium rates. Be wary of a policy that seems too much affordable, as it may not provide the type of health coverage needed. Most health insurance policies also contain exclusions and conditions for pre-existing medical conditions that consumers should understand thoroughly before purchase. It would also be good to know beforehand if rates increase with age and on the amount of out-of-pocket expenses. Policyholders should also have clear understanding on whether service is provided for a lifetime or does it have annual benefit caps, in which case the policyholder might find themselves having to pay for medical expenses that are beyond what is stipulated in the coverage. With the rising cost of prescription drugs, it would also be beneficial if the policy will include coverage for purchasing medications.

There are three types of health insurance plan that are typically offered to residents in Maine. One is Health Maintenance Organization (HMO) plan which health care services are provided through a specific network of doctors and medical facilities. There is also the Preferred Provider Organization plan that uses a group of doctors and hospitals that will provide discounted medical services to the insured. The last type is the Point of Service Plan in which care is provided by an HMO though the policyholder is also allowed to seek out medical care outside the network without prior approval from a HMO doctor.

Some policyholders enrolled in group plans may find themselves seeking to dispute denied claims. In this scenario, it would be good to determine who regulates the health insurance policy they have. It is the right of the policyholder to get a detailed written explanation from the provider on why a claim was denied and should be able to provide information on how to go about filing a dispute regarding the denied claim. The appeal procedure should also be outlined in the health insurance booklet. Policies purchased from private insurance policies and from HMO are regulated by the state while self-funded health benefit plans are regulated by the federal government. Policyholders seeking to file a dispute on state-regulated policies can submit forms to the Maine Bureau of Insurance while federal-regulated policies are handled by the U.S. Department of Labor Pension and Welfare Benefits Administration. Complaint forms must also be supplemented with documentations from the medical care provider as well as the explanation given by the insurance provider on denying the claim.

We help our Maine customers in Portland, Lewiston, Bangor, South Portland, Auburn, Biddeford, Augusta, ME and other cities in the Pine Tree State lower their premiums and save money on all types of insurance. Use the form above to find low cost auto, homeowners, health, medical, life and long term care insurance. Using our Maine insurance agent and broker network, you can easily compare rates from multiple insurers.

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