Are you looking for Low-Cost Generic Medications? Try Cost Plus Drugs. They offer transparent pricing and shipping to you. Homepage of Mark Cuban Cost Plus Drugs

Are you looking for discounts at local and chain Pharmacies? GoodRX, RXSaver and WellRX may have coupons or discounts that can help.

Most Brand-Name Medications have Copay or Prescription Assistance Programs. Find more information and search for your Medication here… NeedyMeds

Has Insurance denied your Medication? CoverMyMeds helps providers push approvals through your insurance.

You can also find Copay help for Brand-Name Medications here… PAN Foundation – Patient financial assistance, advocacy, and education

Do you have a Rare or High-Cost Condition? Check out HealthWell Foundation to see if you qualify for Grant Assistance. When health insurance is not enough – HealthWell Foundation

If you are Underinsured or need financial help, go here and see if you can get support… Home – Patient Advocate Foundation

In Maine, the entity that coordinates the independent external review of health insurance denials is the Maine Bureau of Insurance. 

The Bureau contracts with various independent review organizations (IROs), which are impartial entities not associated with your insurance company, to conduct the review of your case. 

How to Request an External Review

To initiate the external review process, you must typically exhaust your insurance company’s internal appeals process first (usually two levels of appeal for a group plan, or one level for an individual plan), unless it is an expedited case where your life or health is in serious jeopardy. 

1. Contact the Maine Bureau of Insurance: You or your representative should contact the Bureau to request an external review application and determine your eligibility.
   • Website: You can find resources and the application form on the Maine Bureau of Insurance website.
2. Submit Required Forms: The Bureau will send a packet with forms, including an authorization and contact sheet. You must complete and return these forms, along with a copy of your final denial letter from the insurer.
3. IRO Assignment: The Bureau will assign your case to an IRO. The IRO will appoint a health care professional with expertise in the relevant medical issue to review your case.
4. Decision: The IRO’s decision is binding on the insurance company. The process usually takes around 30 days to complete, or 72 hours for expedited reviews. 

Was your Denial for bills for covered Emergency Services?

If the answer is yes, you can request an Independent Dispute Resolution (IDR).

The Maine Bureau of Insurance 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.

For more information about filing an IDR, go here.

AI can help you review medical charges, spot overbilling and ask smart questions. If you get a confusing medical bill, here’s how to fight back:

1. Ask for the full, itemized bill. You’re entitled to it, so go ahead and ask.
2. Remove your personal data before putting into AI. Take a marker and make sure your medical ID, date of birth, full name, SSN and other personal details are not readable.
3. Use your favorite AI tool. Take a picture of the bills and upload them into your AI tool. (I like Perplexity AI.)
4. Ask this question, “Can you find billing errors, duplicates or coding problems in this bill.?”
5. Follow up with this question, “Which charges seem inflated or shouldn’t be billed separately?”

The health care system sometimes counts on you being too overwhelmed to question your bills. AI gives you a secret tool to help. Always question your medical bills.

Have you heard of FairHealth Consumer? This website helps you estimate healthcare expenses by using a CPT code or the name of a procedure. When you get a large bill from a health care facility always call and ask for an itemized bill so you can question the amounts you are charged. https://www.fairhealthconsumer.org

Know what to expect before you receive care in Maine.

CompareMaine reports the average amount paid for common healthcare procedures at different healthcare settings in Maine. The average total payment on this website represents the reporting period July 1, 2023 – June 30, 2024, and is the average amount paid by a commercial payor, including the insured individual’s cost share, to a healthcare setting and/or provider for a healthcare service or procedure. The average payment displayed on CompareMaine does not represent a person’s actual payment, as that amount varies based on individual deductibles and out-of-pocket amounts.

https://www.comparemaine.org

Medicare open enrollment runs from October 15 to December 7, and it’s your chance to update your coverage for the year ahead. You can switch Medicare Advantage plans, change prescription drug coverage, or move back to Original Medicare and select a Medicare Supplement (Medigap). Sounds simple—but the options can be overwhelming.

Why It Gets Confusing

Comparing premiums is just the beginning. You also have to check:

• If your medications are covered.
• Whether your doctors are in the network.
• What your out-of-pocket costs will look like.

Miss one detail, and you could be stuck with higher bills or fewer choices.

How I can Help

As an insurance broker, I am like your personal Medicare guide. I help:

• Compare plans from multiple companies.
• Match options to your doctors, prescriptions, and budget.
• Explain everything in plain language.
• My services don’t cost you a dime.
• I stay by your side all year if issues come up.

Why Check Every Year?

Plans, prices, and drug lists change annually. Even if you’re happy now, it’s smart to review and make sure you’re still getting the best value.

The Bottom Line

Medicare open enrollment doesn’t have to be a headache. With a broker like me on your side, you can skip the stress and choose a plan that truly fits your life.

Medicare Disclosure: I may not offer every Medicare plan available in your area. Any information I provide is limited to those plans I offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options. 

Have you heard about the Maine RX Card. It is no cost for every Maine resident. Here are some more details…

• Free For Everyone. All residents are eligible to get pharmacy discounts through this program. The program may be used to provide savings on prescriptions not covered by your health insurance or Medicare Part D. The program may also be used instead of your insurance coverage when it offers greater savings than your copay.
• No Restrictions. There are no enrollment forms, no age or income requirements, no waiting periods, no eligibility required, no exclusions, covers pre-existing conditions, no claim forms to file, no annual or lifetime limits.
• Lowest Price. This program has Lowest Rx Price Logic to guarantee that you get the best pricing on prescriptions (Card holders pay the lower of a discount off Average Wholesale Price-AWP, discount off MAC Pricing, or Pharmacy Promotional/Retail price). You can save up to 80% on your medications (average savings are roughly 30%)!
• Medications. The program includes discounts on brand and generic medications, open formulary so that all medications are eligible for discounts.
• Accepted Everywhere. The Discount Prescription Card is pre-activated and accepted at over 68,000 pharmacies around the country including most major chains.
• Confidential. No personal information is required to get a card.

https://mainerxcard.com

Did you know there is a free tool you can use to see why your health insurer denied your insurance claim? ProPublica’s Claim File Helper lets you customize a letter requesting the notes and documents your insurer used when deciding to deny you coverage. Get your claim file before submitting an appeal.

Start your claim file request here.

Do you have unpaid medical bills? Here are some tips from unduemedicaldebt.org.

1. Don’t pay with your credit card unless you have the money available.
2. Ask for financial assistance, even if your hospital stay was a year ago
3. When you apply for financial assistance, let them know about other large bills you have. Even if your income is good, you may not be able to pay.
4. If you don’t get financial assistance, ask for a payment plan.
5. Do you struggle with negotiation? Get a friend to do the call with you.
6. No one returning your call? Contact the hospital Patient Representative.
7. Don’t stop taking medications or going to the doctor.

The Easy Enrollment Tax Referral Program is the “check the box’ option on your Maine state tax return form 1040ME to opt-in to receive more information about the health insurance options available to you. When you opt-in, you authorize the Maine Revenue Services to share your name and contact information with CoverME.gov. We will use this information to send you a communication about how to get enrolled. 

How it works

• Check all boxes on form 1040ME that apply to your household. Let us know that you’d like more information about health insurance coverage, who the coverage would be for, and how you prefer to be contacted. By checking the boxes, you give the Maine Revenue Services permission to share your contact information with CoverME.gov. Here’s an example: 

• File your taxes. After you file your taxes, the Maine Revenue Services will share your contact information with CoverME.gov so we can contact you with more information. 
• Watch for the CoverME.gov communication. Once we receive your information, CoverME.gov will contact you by mail, phone or email to explain how to enroll in health coverage. You’ll have 35 days from the date we contact you to sign up. 
• Contact me and I will help you get enrolled. You can link me to your coverme.gov account by clicking on get help or get assistance. Type in Stacy Dostie, and select me. I will receive notification that you need assistance and I will contact you to setup a time to meet.