Navigating Medical Bills and Debt

A practical guide for current and former

foster youth and their adult allies in Maine

October 2016

~Field Test Version~ Available at www.maine.ytc.org/navigating-medical-bills-debt/

Dear Reader:

When I was 15 and a sophomore in high school, I gave birth to a baby girl named Emma May. While I was pregnant, a

school faculty member had helped me to get Mainecare (state insurance) for my daughter, which went into effect one

month before she was born. I finished my honors classes from home with a tutor and spent that summer getting the

hang of parenting. My mind was consumed with learning to breastfeed, broken sleep, summer reading and trying to get

out of the house here and there. At 15, with a baby who had full-benefit state insurance, never did medical bills even

cross my mind.

Fast forward two and a half years, and I would find myself homeless after fleeing multiple abusive living situations.

Determined to get my daughter’s and my life on track and to live independently from the shelter, I went straight to work

securing a job, getting us set up with proper medical care, and finding us an apartment to move into. I experienced

many successes – getting to our appointments on foot during the winter was a feat in itself – and things were really

moving in the right direction.

I found an apartment that was within my price range and arranged a viewing with the owner. I dressed up as best I could

with clothing from the homeless teens’ clothing closet and bussed my way over, making it there early. The place was

beautiful, the owner friendly, and everything seemed to go well. Afterwards, I went back to the teen center to express

my excitement with peers and staff. But an hour later, I got a call saying I’d been denied. Incredulous, I asked why, and

the owner said grimly: “Bad credit.”

I was shocked to hear that I had bad credit. I was barely 18, had no bills that could’ve been overdue, and hadn’t even

dealt a whole lot with money at that point. Heartbroken and confused, I retrieved my credit report with the help of teen

center staff and looked it over. My stomach dropped when I saw I had 9 accounts in collections, most of which were in

my daughter’s name, from her birth 3 years before.

I called the property owner to tell him it was a mistake and that I was disputing it, but he said to contact him once it was

resolved. I realized that while I was in the process of getting this fixed somehow, my housing options for myself and my

daughter would be much more limited. The complicated issue became much more time-sensitive and scary.

I worked hard to figure it out on my own, but communicating with collections, the original provider, the provider’s billing

company, and Mainecare was a confusing process that I was not prepared to navigate alone, and it ended up taking

about a year. I received conflicting information from the agencies about how I should handle it, was given false

information about which agency was responsible for what in the process, was turned around in circles by each person I

spoke with, and spent all the minutes on my free phone waiting on hold. Until the very end, I wasn’t sure whether I was

going to be held responsible for the full amount of the bills or not, or whether they would be fully cleared from my

credit report.

Ultimately, the original provider wrote them off due to their lack of timely filing with my daughter’s insurance, and the

marks were removed from my credit report. However, this fight took hundreds of phone calls, probably days of my life

waiting on hold, and many extra steps that could’ve been avoided if I, and my providers had a better idea of how to

handle the situation. It is our hope that this medical debt guide can help youth and their providers to better navigate

this scary and complicated world together, and to tackle and reduce young adults’ medical debt with clarity and

confidence.

Table of Contents Section 1: Introduction ...................................................................................................... 1 Who Should Use This Guide? .................................................................................................1 How to Use This Guide ...........................................................................................................1 Provide Feedback ...................................................................................................................2 Section 2: Medical Bills and Medical Debt: What is the difference? .................................... 3 Young People in Foster Care and Public Health Insurance Coverage – MaineCare ..............5 Section3: Medical Debt Assessment Tool .................................................................................6

Tool – Medical Debt Assessment .....................................................................................7 Section 4: Health Insurance and affordable health care: What Can You Get? How Do You Get It .......................................................................................................................... 10 MaineCare Eligibility ..............................................................................................................10 Private Insurance Eligibility ....................................................................................................11 School Insurance ....................................................................................................................11 Tool – Coverage While in School Decision .......................................................................12 Marketplace Insurance ..........................................................................................................12 An Overview of the Health Insurance Marketplace .........................................................13 How to Enroll in the Health Insurance Marketplace ........................................................14 Are You in the Gap? .........................................................................................................15 Marketplace Enrollment ..................................................................................................15 Getting Help with the Marketplace .......................................................................................16 Coverage: Which Services Are Covered? ...............................................................................17 MaineCare Benefits Packages ..........................................................................................17 Private Insurance Benefits Packages ...............................................................................18 Hospital Free Care and Local Clinics Eligibility .............................................................................20 Hospital Free Care ............................................................................................................20 Community Health Centers ..............................................................................................21 Section 5: Getting Your Insurance to Pay Your Bills ............................................................ 22 Understanding the Explanation of Benefits or EOB ...............................................................23 Understand the Provider Bill .................................................................................................25 Cost Sharing: How Much of the Bill is Covered? ....................................................................25 Cost Sharing and MaineCare ...........................................................................................26 Cost Sharing and Private Insurance .................................................................................26 Free Preventive Care ..............................................................................................................26 Make Your Insurance Plan Work for You ...............................................................................27 What To Do if This Process Doesn’t Work .............................................................................27

Tool – Making Your Insurance Plan Work for You ...........................................................28 Section 6: Medical Debt and Collections ............................................................................ 31 Paying Medical Debt ..............................................................................................................32 Tool – Paying Medical Debt .............................................................................................32 Dealing with Medical Debt in Collections ..............................................................................33

Tool – Dealing with Medical Debt in Collections ..............................................................34 Sample Debt Collector Response Letter When You Don’t Owe the Debt .........................37 Sample Debt Collector Response Letter When You Question the Debt ............................38

You Have Right in Debt Collection .........................................................................................40 Section 7: Medical Debt and Credit Reports and Scores ..................................................... 42 Credit Reports ........................................................................................................................43 Credit Scores ..........................................................................................................................43 Tool – Medical Debt and Credit .......................................................................................44 Annual Credit Report Request Form ................................................................................49 Sample Debt Verification Letter .......................................................................................50 Sample Credit Report Dispute Letter................................................................................52 Section 8: Closing .............................................................................................................. 53 Section 9: Getting More Help: Who to Contact .................................................................. 54 Section 10: Acknowledgements ......................................................................................... 56

Section 1: Introduction This guide provides staff helping young people who have transitioned out of foster care navigate medical billing and debt. It can also help young people take advantage of health insurance options to prevent future debt. For a young person who is or has been in foster care, dealing with the financial realities and emotional stress caused by medical bills and debt can be overwhelming. The primary goal of this guide is to ensure young people are not paying bills that should be covered by insurance or hospital free care. They should only pay medical debts that legitimately belong to them. This protects their financial stability and credit history.

Who Should Use This Guide? This guide is specifically designed for transition workers, case managers, frontline staff, and other adult allies that work with young people that are in or have been in foster care. However, this tool can be used by anyone dealing with medical billing and debt. While some of the information is specific to youth with a foster care history, much of it applies more broadly.

How to Use This Guide This guide contains information on managing medical bills and debt. It also covers the related impact on credit reports and scores. The guide is not meant to be used in its entirety when working with a young person. However, in some cases, you may find that all of the information is necessary to resolve a situation. In most cases, it should be clear how to match the section within the tool to the most pressing situation the young person is facing. There are two efficient ways to find the right content. You can start with the assessment in Section 3. Use a young person’s answers to the questions in the assessment to find the right starting point within the guide. You can also use the table of contents to find the section that best matches the issue a young person is experiencing.

Objectives of this Guide

Staff helping young people in or who have

transitioned out of foster care will have the

information and referral resources necessary to

help young people:

1. Ensure that they are not being unnecessarily charged, double-billed, or overcharged in any way for medical care they have received.

2. Determine whether health insurance resources have been properly applied in order to avoid the creation of personal medical debt.

3. Apply for free care and in cases where billing is appropriate, negotiate a fair and manageable payment plan.

4. Verify medical debt to ensure it belongs to the young person and the firm collecting the debt has the legal right to do.

5. Decide how to prioritize the payment of legitimate medical debt in relation to other living expenses.

6. Determine when medical debt that has been charged off should no longer reported on their credit reports.

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The information contained within this guide is for educational purposes. The information and tools also do not constitute legal interpretation or advice on the part of the individuals involved or the organizations for which they work.

Provide Feedback To ensure the tool is working effectively, the authors welcome your feedback. After using this tool with a young person, you are invited to complete a short evaluation online at https://www.maine-ytc.org/navigating-medical-bills-debt/. Your thoughts about using the tool will help improve future editions.

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Section 2: Medical Bills and Medical Debt: What is the difference? Before using this guide, it’s important to understand the differences between medical bills and medical debt. A medical bill is a list of products or services with a statement of how much money is owed. You get a medical bill after getting medical services. Once you get a medical bill, you must pay the amount or make a payment arrangement. It’s best to always request an itemized bill so you can see exactly what you and your insurance provider, including MaineCare is being billed for. This generally requires making a special request to your health care provider’s billing department. Medical debt occurs when you have not paid your medical bills. For some health care providers, the billing department will contact you directly to collect the amount you owe. Other health care providers may use a business that specializes in collecting debts—a third party debt collector. To add to the confusion, if you have health insurance you may also receive an Explanation of Benefits (EOB). Unlike medical bills, an Explanation of Benefits or EOB explains: The kind of service you got The date of service The cost of the services The amount billed to insurance, including MaineCare and Medicare The amount not covered by insurance, if any The expected total cost to you

Because an EOB looks a lot like a bill, people often mistake it for a bill for services, but it is not. A bill for services comes from the provider and an EOB comes from the insurance company.

MaineCare versus Medicare: What is the difference?

Medicaid, called MaineCare in Maine, is a needs-based insurance program. It serves people with low-income. MaineCare members usually pay no copay or a very small copay for covered medical expenses. It is a federal and state program. It’s run by state and local governments within federal guidelines. Medicare is an insurance program that people pay into over time through payroll taxes. It serves people over 65 years of age, whatever their income, and people with disabilities or on dialysis. Members pay part of costs through deductibles and coinsurance for hospital and other services. Monthly premiums are required for non-hospital coverage. Source: U.S. Department of Health and Human Services

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EOBs (Explanation of Benefits) should be reviewed and compared to bills. If there is a difference between them, contact your healthcare provider. Be sure to check both the EOB and the medical bills you get for errors including: Duplicate charges Charges for cancelled tests or procedures Incorrect identifying information—incorrect or misspelled names, incorrect policy or insurance

identification numbers, incorrect date of birth or address, and so on Separated charges that should be billed under the same code. This is called unbundling and

can be hard to spot. A common example is for lab work often ordered by doctors and performed by the lab as a group. These tests can sometimes be coded one by one so the provider can charge more.

Coding for procedures more expensive than those actually performed. This practice is called “upcoding.”

Balance billing—is the difference between the amount the insurance company and health care provider agreed on that a service or procedure would cost AND the amount the health care provider decides to charge. Maine does not allow balance billing unless you use a health care provider that is out of your network. Your network is the list of health care providers approved by your insurance plan. There is no balance billing if your insurance plan is MaineCare.

Operating and anesthesia time—check these times are accurate.

More information on understanding the EOB can be found in Section 5 of this guide.

Explanation of Benefits— MaineCare and Medicare

If you have health care coverage through MaineCare, you may receive an Explanation of Benefits (EOB). This provides information about services that were supposed to have been provided to you by health care providers. States are only required to send EOBs to a random sample of Medicaid patients. If you receive an EOB, you are asked to review them to make sure you received all of the services listed on the EOB. For other Medicare coverage, you may receive a Medicare Summary Notice (MSN).

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Young People in Foster Care and Public Health Insurance Coverage—MaineCare Young people who are under the age of 26 years old and who transitioned out of foster care in Maine at age 18 or later automatically qualify for MaineCare. If a young person has medical bills or debt and is or was already enrolled in MaineCare, there are steps to follow to get the bills or debt covered.

Steps to Take for Bills and Debt if You are Currently Covered by MaineCare

If the bill was incurred while you had MaineCare, ask the healthcare provider or collection agency to send the bill to or rebill MaineCare. Give the provider office your MaineCare member number. If the bill was incurred before you got MaineCare, or during a time when your MaineCare was inactive, was it during the 90 days before your current MaineCare enrollment began? If yes: Call DHHS and ask them to make MaineCare retroactive to cover the bill.

If no: Had you applied for MaineCare earlier and been denied? Did this denial add extra time to

get into MaineCare?

Yes? Call Consumers for Affordable Health Care: 1-800-965-7476. CAHC can figure out if you were denied incorrectly for MaineCare. CAHC can help you get MaineCare going back in the past to cover bills, even more than 90 days, if you were eligible.

No? Call Consumers for Affordable Health Care: 1-800-965-7476. CAHC can help you figure out if you can get free care, or other options.

If you have medical debt and you don’t have MaineCare now but are a former foster youth who aged out at 18 or beyond and you aren’t 26 yet, you should have MaineCare. Get enrolled immediately the fastest way you can. You can sign up and apply at maine.gov/mymaineconnection and be sure to click submit. Otherwise, go to a DHHS office and explain you are eligible and need to enroll. When an eligible person applies, MaineCare can cover bills up to 90 days in the past. If you don’t have MaineCare because you were incorrectly denied, call Consumers for

Affordable Health Care for help: 1-800-965-7476

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Section 3. Medical Debt Assessment Tool To use this guide efficiently, you can start with this assessment. This tool will help you identify the most pressing issue or issues a young person is facing related to medical bills and debt and point you to a specific section in the tool to use first. You can print out the form and give it to the young person you are working with to complete, ask the questions and record the answers, or weave the questions into a general conversation with the young person. Be sure to look at the “What to Do Now” section, which will provide direction within the guide based on the young person’s answers.

SEE TOOL ON NEXT PAGE

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Tool: Medical Debt Assessment To get a quick picture of some of the issues related to medical bills or debt a young person may be facing AND to determine which section of the guide may be most relevant, complete this short questionnaire.

1 Do you have healthcare coverage? Yes No I don’t know

2 Are you or have you been in the foster care system in Maine?

Yes No

I don’t know

3 Did you age out of care when you were at least 18?

Yes No I don’t know

4 Are you under age 26? Yes No I don’t know

5 Do any of these statements apply to you? You are pregnant. You have a disability. You provide a home for a minor child.

Yes No I don’t know

6 Are you in college? Yes No I don’t know

7 Are you not getting health care because you can’t pay for it? This includes routine trips to the doctor or dentist.

Yes No I don’t know

8 Are you not using your healthcare coverage because you feel confused about what is covered?

Yes No I don’t know

9 Do you have medical bills you cannot pay for? Yes No I don’t know

10 Do you have medical debts in collections? Yes No I don’t know

11 Have you received notice of a lawsuit from a healthcare provider because of medical debts?

Yes No I don’t know

12 Are you concerned about what your medical debt in collections has done to your credit reports or scores

Yes No I don’t know

13 Are there other issues related to healthcare you are concerned about?

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What To Do Now Find your answer to the question(s) you are most concerned about first. This can give you a starting point for using the information and tools in this guide.

1 Do you have healthcare coverage?

If you answered yes, visit: “Making Your Insurance Plan Work for You” in Section 5 to ensure you are getting the best from your plan

If you answered no or I don’t know, check to see if you answered yes to any one of the questions 2 – 5. If you answered yes, see “MaineCare Eligibility” in Section 4. If not, see “Private Insurance Eligibility” in Section 4.

2 Are you or have you been in the foster care system in Maine?

If you answered yes, you may be eligible for health insurance coverage through MaineCare. See Section 4.

If you answered no or I don’t know, visit the section on “Private Insurance Eligibility” in Section 4. You may also want to review the information on “Hospital Free Care and Local Clinics Eligibility” in Section 4 if you have low income.

3 Did you age out of foster care when you were at least 18?

If you answered yes, you may be eligible for health insurance coverage through MaineCare. See Section 4.

If you answered no or I don’t know, visit the section on “Private Insurance Eligibility” in Section 4. You may also want to review the information on “Hospital Free Care and Local Clinics Eligibility” in Section 4 if you have low income.

4 Are you under age 26?

If you answered yes, you may be eligible for health insurance coverage through MaineCare. See Section 4.

If you answered no or I don’t know, visit the section on “Private Insurance Eligibility” in Section 4. You may also want to review the information on “Hospital Free Care and Local Clinics Eligibility” in Section 4 if you have low income.

5 Do any of these statements apply to you? You are pregnant. You have a

disability. You provide a

home for a minor child.

If you answered yes, you may be eligible for health insurance coverage through MaineCare. See Section 4.

If you answered no or I don’t know, visit the section on “Private Insurance Eligibility” in Section 4. You may also want to review the information on “Hospital Free Care and Local Clinics Eligibility” in Section 4 if you have low income.

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6 Are you in college? If you answered yes, visit the section on “School Insurance” in Section 4.

If you answered no or I don’t know, determine if you are eligible for health insurance coverage through MaineCare. See Section 4.

7 Are you not getting health care because you can’t pay for it? This includes routine trips to the doctor or dentist.

If you answered yes, see the section called “Coverage: Which Services are Covered” in Section 4.

If you answered no, that’s great. Keep using your healthcare to get preventative services. If you answered “I don’t know,” see the section called “Coverage: Which Services are Covered” in Section 4.

8 Are you not using your healthcare coverage because you feel confused about what is covered?

If you answered yes, visit the section called “Getting Insurance to Pay Your Bills” in Section 5.

If you answered no, that’s great. I don’t know, visit the section called “Getting Insurance to Pay Your Bills” in Section 5.

9 Do you have medical bills you cannot pay for?

If you answered yes, visit the section called “Getting Insurance to Pay Your Bills” in Section 4.

If you answered no, that’s great. If you answered “If you don’t know,” visit section on “Medical Debt and Credit Reports and Scores” in Section 7. Outstanding medical bills may be reported on your credit reports.

10 Do you have medical debts in collections?

If you answered yes, visit the section called “Medical Debt and Collections” in Section 6.

If you answered no, that’s great. If you answered “I don’t know” get your credit report to find out if you do. See the “Medical Debt and Credit Tool” in Section 7 to learn how to get your credit reports.

11 Have you received notice of a lawsuit from a healthcare provider because of medical debts?

If you answered yes, immediately contact Pine Tree Legal Assistance at http://ptla.org or 1-207-774-8211.

If you answered no but you have medical debt, visit “Medical Debt and Collections” in Section 6. If you answered “I don’t know” but think there is a chance you may have received a notice of a lawsuit immediately contact Pine Tree Legal Assistance at http://ptla.org or 207- 774-8211.

12 Are you concerned about what your medical debt in collections has done to your credit reports or scores?

If you answered yes, visit the section called “Medical Debt and Credit Reports and Scores” in Section 7.

If you answered no or I don’t know, consider visiting this section on “Medical Debt and Credit Reports and Scores” in Section 7. Even if you don’t have concerns about medical debt, checking your credit reports is good for your financial health!

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Section 4: Health Insurance and Affordable Health Care: What Can You Get? How Do You Get It? Most programs have eligibility rules. This goes for insurance, too. The following sections describe basic eligibility for some public and private insurance as well as some other safety net programs like hospital free care and sliding fee clinics. This information can help you figure out what options may work for you.

MaineCare Eligibility MaineCare is the public health insurance program in the state of Maine. To be eligible for MaineCare, you must be in at least one of these groups: Group 1—Former foster child under 26 years old who aged out of care in Maine at age 18 or later Group 2—Under 21 years old Group 3—Maintaining a home for a minor child at least half the time Group 4—Pregnant Group 5—At least 65 years old Group 6—Disabled If you are in Group 1 you don’t have to meet any other requirement. Your income and assets don’t matter at all. For all the other groups, your household income has to be below a certain level to qualify. The limits change a bit each year and are different for each group. If you are in groups 2, 3, 4, 5, or 6, see the chart later in this Section to learn about income limits for 2016.

You can apply for MaineCare any time of the year. You can apply online at maine.gov/mymaineconnection. You can also apply online at a kiosk in any Department of Health and Human Service (DHHS) office. Or you can fill out a paper application and mail it in.

Insurance a Priority at Any Age: John’s Story John was 21, uninsured, and working for his brother, a builder. While on the job, he fell off a roof and hurt his back. He was out of work for months, but not long enough or permanently enough to get MaineCare. His family and friends tried to raise money for his treatment with fundraisers. But his bills were high- he could have bought six new cars with the money needed to pay them. He did get hospital free care for the initial treatment but that didn’t cover the therapy he needed as he began to heal, and it will take him years to pay off the bills that could have been covered by insurance.

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How to get a MaineCare paper application: Ask at any DHHS office. To find a DHHS office near you, go online to: gateway.maine.gov/dhhs-

apps/office_finder/ Paper applications can be downloaded and printed from: www.maine.gov/dhhs/ofi/public-

assistance/pdf/On-Line-CubCare-Application.pdf Call Consumers for Affordable Healthcare (CAHC) at 1-800-965-7476. Staff there will mail one to

you. If you think you should get MaineCare but are denied, call CAHC at 1-800-965-7476. Sometimes applications are denied by mistake. For example, the eligibility category for former foster youth is new. Not everyone remembers it.

Private Insurance Eligibility There are several ways to get private insurance: From an employer Through a college From the Health Insurance Marketplace. This is often called “Obamacare.” Young adults can remain on a parent’s private insurance plan up to age 26.

If your employer offers you insurance, it may mean you can’t get Obamacare, unless the plan your employer offers is too expensive.

School Insurance You may be able to get insurance through your college. Your school may say that you have to have health insurance. You may have to pay for it through your school loans, and it may only cover health care that you access on campus. If you are in college and can get MaineCare or other private insurance, you don’t have to take the college insurance. The school just wants to be sure you have good coverage.

What about former foster youth from Maine who move or go to college out of state?

If a MaineCare member moves to another state, that person will no longer be eligible for MaineCare. If a MaineCare member goes to college in another state, MaineCare will only cover emergency services in that other state. Are you a former foster child who aged out of care in Maine, but are now in another state, either

for school or as a result of a permanent move? You can find that state’s Medicaid program and ask

if former foster children who aged out in a different state are eligible for Medicaid in that state.

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If you are eligible for MaineCare, that is nearly always your best choice as it is good coverage and nearly free. If you go to school out-of-state, MaineCare may not cover healthcare expenses unless it is an emergency. You may also be able to use MaineCare out-of-state if needed care is not available in Maine. In this case, prior authorization is needed. If you can’t get MaineCare, but can get insurance through your job and it doesn’t cost too much, it is likely best to take that instead of the school insurance.

Marketplace Insurance If you can’t get insurance through an employer, college, or MaineCare1, then the Marketplace (ObamaCare) may be a good option for you`. Your income must be at least 100% of the Federal Poverty Level to get help paying for a plan in the Marketplace. The Federal Poverty Level usually changes a little each year. In 2016, it is $990 a month if you are over 20 and single with no children.

1 Remember, you automatically qualify for MaineCare if you are a former foster child under 26 years old who aged out of care in Maine at age 18 or later.

Tool: Coverage While in School Decision If you are in college, use this tool to help guide your decision about where to get health insurance coverage. Are you in or were you formerly in foster care in Maine? YES NO

Are you going to school in Maine? YES NO

Are you under the age of 26? YES NO If you answered yes to all of these questions, MaineCare is probably the best health care coverage choice for you while you are in school. If you answered NO to any of these questions, you may need to check whether you are still eligible for MaineCare. If you are not eligible for MaineCare, you may want to explore getting health care coverage through the school or an employer if you have a job. Are you going to school outside of Maine?

YES NO If you answered yes to this question, you will need to explore health insurance through your school or through an employer if you work part- or full-time. If you were adopted and your parents have insurance, you can be covered under their insurance plan up to age 26.

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An Overview of the Health Insurance Marketplace Each state has a Health Insurance Marketplace. Some states have their own Marketplace and many including Maine use the Federal Marketplace. It is online at healthcare.gov. But you can get free, expert local help. To find enrollment assisters in your area go to www.enroll207.com/locator/. Or, you can call CAHC at 1-800-965-7476 to find the closest assister. There is no fee for talking with enrollment assistors. The Marketplaces were meant to help people who had no other way to get coverage and are above the poverty level. Under ObamaCare, it was assumed that all Mainers under the poverty level would get free insurance through MaineCare. But the Supreme Court decided that the federal government couldn’t force states to give free health coverage to people with low incomes. Each state has to decide if they want to expand Medicaid eligibility to include everyone under the poverty level. As of 2016 Maine has not done so. As a result, there are still some people without an affordable option for health insurance.

The Marketplaces were meant to help people who had no other way to get coverage and are above the poverty level. Under ObamaCare, it was assumed that all Mainers under the poverty level would get free insurance through MaineCare. But the Supreme Court decided that the federal government couldn’t force states to give free health coverage to people with low incomes. Each state has to decide

Poverty Level for 2016 The Federal Poverty Level is used to determine eligibility for government programs including Obamacare. This table shows the annual and monthly income levels of poverty for 2016. If you are a single person and have an income of $11,880 then you are at 100% of the poverty level. These amounts change a little each year, so be sure to get the most recent information at: https://www.healthcare.gov/glossary/federal-poverty-level-FPL/

Family Size Poverty Level - Annual Income Poverty Level - Monthly Income

Individual $11,880 $990

Family of 2 $16,020 $1,335

Family of 3 $20,160 $1,680

Family of 4 $24,300 $2,025

Family of 5 $28,440 $2,370

Family of 6 $32,580 $2,715

Family of 7 $36,730 $3,061

Family of 8 $40,890 $3,408

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if they want to expand Medicaid eligibility to include everyone under the poverty level. As of 2016 Maine has not done so. As a result, there are still some people without an affordable option for health insurance.

In Maine, if you are in one of these groups, you may be eligible for MaineCare: Group 1—Former foster youth under 26 years old who transitioned out of care in Maine at 18 or later Group 2—Under 21 years old Group 3—Maintaining a home for a minor child at least half the time Group 4—Pregnant Group 5—At least 65 years old Group 6—Disabled If you are in Group 1 you don’t have to meet any other requirement. Your income and assets don’t matter at all. For all the other groups, your household income has to be below a certain level to qualify. The limits change a bit each year and are different for each group. If you are in groups 2, 3, 4, 5, or 6, see the chart on the previous page to learn about income limits for 2016. If you are not in one of these groups, you can’t get MaineCare even if you are under the poverty level. However, if your income is over the poverty level you may be able to enroll in a plan at the Marketplace and get financial help from the government to lower the cost of your plan. You can enroll on your own, or with the help of someone in person.

How to Enroll in the Health Insurance Marketplace To enroll, you can make an appointment to get local assistor help. Go to www.enroll207.com/locator or call 1-965-7476 to find an assistor near you. You can also enroll yourself by setting up an account at healthcare.gov and selecting a plan. For a first time, it’s usually better to get the free, local assister help. If you get a plan on the Marketplace, eligible applicants automatically geta tax subsidy to help pay for it based on your income. A tax subsidy makes the price of the plan cheaper for you. The tax subsidy is the part the government chips in to reduce your monthly insurance premium. The tax credit help is on a sliding scale so that the higher your income, the lower your tax credit. The sliding scale is based on income between 100% and 400% of the federal poverty level. The government sends part of your payment each month to your chosen insurance company. This is called an Advanced Premium Tax Credit. It works with the IRS, so you must file taxes yearly to keep getting it, even if you otherwise don’t have to file.

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Are you in the Gap? You may be in what is called “the gap” if you are under the poverty level and: Were not in foster care in Maine when you turned 18 Do not maintain a home for a minor child Are not pregnant Are not disabled Are over the age of 20 Have no other source of health insurance at school or job

If these describe you, unfortunately there is a gap in coverage for you. You would have to pay full price to buy a plan in the Marketplace. You would get no tax subsidy help. This can be costly. But, full price for an insurance plan in the Marketplace is cheaper for younger people than older people. You can get a price quote and then decide. Almost anyone can buy a plan in the Marketplace. The big question is if you can get a tax credit to help pay for it. If you can’t get insurance from a job and your income is at least 100% of the Federal Poverty Level, a Marketplace plan may be good for you because you can get the tax credit to help pay for it.

Marketplace Enrollment People can sign up in the Marketplace only during certain times. This is to keep people from signing up only when they find suddenly need care. The most common time to get a plan is during Open Enrollment, which is from November 1 to January 31. If you miss the Open Enrollment period, you may be able to enroll if you: Have lost other insurance within the last 60 days. Are about to lose other insurance in the next 60 days Have had another life event (see box on the next page).

These circumstances may qualify you for a Special Enrollment Period. If you’re losing other insurance, you have 60 days before the loss and 60 days after it, to sign up in the Marketplace during a Special Enrollment Period.

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Getting Help with the Marketplace

In Maine, there are people who will help you sign up. "Navigators" or "certified application counselors" provide free in-person assistance to help you review health plan options and sign up for health insurance. 2 They are called enrollment assistors. You can find them at http://www.enroll207.com/locator/. Or call CAHC at 1-800-965-7476 and ask where there are Marketplace Enrollment Assistors near you.

2Enroll207.com

Enrolling During Special Enrollment Periods

You may be able to enroll in the Marketplace Insurance outside of Open Enrollment if you’re eligible for a special enrollment period or SEP. Certain life events make you eligible for SEPs. You’ll need to show documents of proof. Here are examples of Life Events: Loss of other qualified health coverage Changes in household like marriage, divorce, birth or death of family members Permanent changes in residence to an area with different plans Other qualifying events

Certain changes in your income that affect the coverage you qualify for

Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder

Becoming a U.S. citizen

Leaving incarceration (jail or prison)

AmeriCorps members starting or ending their service

Source: Healthcare.gov

Requirement to Have Health Insurance By law, most people are now required to have health insurance. You can apply for MaineCare, find insurance on the Affordable Care Act Insurance Marketplace, or participate in an insurance plan offered through your school or your employer. If you don’t have insurance, you will have to pay a penalty when you file your taxes unless you are exempt. Exemptions are available based on a number of circumstances, including certain hardships, some life events, health coverage or financial status, and membership in some groups.

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The assistors will help you sign up for the plan you want. They don’t charge anything. They must tell you about all of the plans. But they can’t push you to choose one over the other. You can also sign yourself up at https://www.healthcare.gov/. Even if it’s not Open Enrollment, you can

look at plans. But you can only sign up during Open Enrollment or if you are in a Special Enrollment

Period. Before you sign up, make sure to read Coverage: Which Services Are Covered (below) and feel

confident that you understand your plan.

Coverage: Which Services Are Covered? Coverage is the word used in insurance to describe what services, procedures, or medications insurance companies will pay for and how much they will pay. This is different for every plan. There are two big things to check. Is the doctor or health care provider you want in the network for your exact plan?

A network is a group of health care providers that is covered by your insurance plan. You must get covered services from in-network providers to use your insurance wisely. Your insurance may cover a specific service only in network. Or it may cover more of the cost of the service when provided by an in-network provider. This means you would have to pay less of the bill. If you don’t have a provider yet, ask the insurance company for a list in writing of providers they cover who are taking new patients.

Is the service or procedure you need covered? Even if a medical care provider is covered, the service or procedure you may want or need may not be covered. It is important to make sure the service itself will also be covered. Often, office staff will help you find out if a service, procedure, or medication is going to be covered by your insurance plan. You can also call the customer service number on your insurance card to ask if a specific service is covered.

MaineCare Benefits Packages MaineCare covers different services for different groups of people. Children have more covered services than adults. If you are not yet 21 years of age, MaineCare will cover most health care services you can think of. Even if you are over 21, MaineCare pays for many different services and procedures, including doctor visits, prescription medications, and hospitalizations. MaineCare coverage for members under age 21 includes additional screening, diagnosis and treatment for medical, vision, hearing and dental services. It also includes immunizations, laboratory tests, including lead blood tests, and health education. If you have MaineCare, here are ways to find out what it covers for you: Call MaineCare Member Services at the number on your Member Card: 1-800-977-6740. Look it up in the MaineCare Member Handbook. If you don’t have one, find it online at:

www.maine.gov/dhhs/oms/pdfs_doc/member/mainecare_mbr_handbook.pdf Call CAHC at 1-800-965-7476.

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Remember, you must be sure that you only get services from providers who are in the MaineCare network. This means they accept MaineCare. Many medical providers in Maine do, but you must check to be sure! Only some dental providers take MaineCare, so check by calling the dental office. Ask, “Do you take MaineCare?” If a health care provider doesn’t take MaineCare, but you’re a MaineCare member and get a service from them, it becomes your medical bill! In addition to making sure the provider takes MaineCare, check to be sure MaineCare covers the service or medicine you want also. For some things, you may also need to get permission or a “prior authorization” from your doctor to get the service or medicine covered.

Private Insurance Benefits Packages Maine has many insurance companies that sell different health insurance plans. There are different companies selling plans in the Health Insurance Marketplace. There are many other companies selling plans through employers and at schools. Every plan is different! But there is one way they are almost all the same. The Affordable Care Act requires that almost all plans must cover ten essential health benefits:

1. Ambulatory patient services: this means doctor’s office visits, such as an appointment with your primary care provider

2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health, substance use disorder services and behavioral health treatment 6. Prescription drugs 7. Rehabilitative services and devices 8. Laboratory services 9. Preventive services, wellness services, and chronic disease management----this includes

checkups, immunizations, asthma or diabetes management, and others 10. Pediatric services including dental and vision services

Does MaineCare cover ambulance

services?

Some ambulance services fall under

routine care if they are for non-

emergency transportation. But other

ambulance services are considered

emergency. MaineCare will cover

emergency services for MaineCare

members.

Sometimes, MaineCare gets wrong

information from a provider and may

deny coverage for the service. In this

case you should try to get the provider to

resubmit the service. You have the right

to appeal all MaineCare decisions. To

appeal, call any DHHS office in Maine and

say you want to appeal a MaineCare

decision or request or a Fair Hearing.

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The ten essential health benefits are big categories. Each plan has a document called the Summary of

Benefits and Coverage, commonly called the SBC. The SBC gives you lots more information about each

specific plan’s coverage.

Many times, costs are shared between you and the company. The SBC explains how that cost sharing works. If you buy a plan, you should get a copy of your SBC. You can also see them online before buying a Health Insurance Marketplace plan. But the SBC gives examples, not a list of everything that is covered. Different plans cover different medicines. If you are looking at plans and need a specific medicine, you can find out if it’s covered. If the plan has its SBC online, as all Marketplace plans do, you can click on the link that says “list of covered drugs.” This is also known as a formulary. This takes you to a long list of medicines in categories and alphabetical order. If your plan is an employer plan instead of a Marketplace plan, call the Member Services number on your card. Ask for the link to the formulary or covered medications list. Be aware that companies can and do change the medicines they cover often. Many companies cover some medications better than others. Medications that cost the least may be called generic or tier-one meds. Tier-two or three medications may be brand name or specialty drugs and may cost you a lot more. If your medication is not in tier one, ask your doctor if there is a tier one medication you can take.

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Hospital Free Care and Community Health Centers

Hospital Free Care If you think you can’t get insurance through any of the ways already described, there is still some help for you. In Maine, the law says people with incomes less than 150% of the Federal Poverty Level can get hospital free care, sometimes called financial assistance. Some hospitals offer free care to people with incomes higher than 150% of the poverty level, but that care must be medically necessary. What is considered medically necessary depends on the policy of each hospital. Medically necessary always includes true emergencies. It may include other things too. If you have MaineCare, you don’t need hospital free care. But if you have other insurance, you can use it with hospital free care. In Maine, hospital free care pays bills the insurance doesn’t. Insurance pays first. Hospital free care pays second.

Figuring Out What is Covered by Your Insurance Step 1: Call the medical provider and ask if they are in-network AND a preferred provider for your insurance company’s exact plan you have. Step 2: Call the member services number on your insurance card. Tell them what service you want to get and where you want to get that service—the name of the medical providers. Step 3: They may give you an answer on the phone, but ask them to put that in writing and send it to you. They may also tell you that the service is not covered. Or they may tell you to get prior authorization from your doctor. If you need prior authorization, ask your doctor’s office send it. Step 4: If they will not cover the procedure or the treatment provider, you can appeal. The process will be different for each insurance provider. In general, your appeal will be stronger with a letter from your doctor stating the reasons that the service and provider are the best option for you. For more help on the appeal process, call CAHC at 1-800-965-7476.

Hospital Free Care and 150% of Poverty Level

In Maine, if your income is less that 150% of the Federal Poverty Level you can get hospital free care. This chart shows 150% of the Federal Poverty Level on an annual and monthly basis.

Family Size

150% of Poverty Level - Annual

Income

150% of Poverty Level - Monthly

Income

Individual $17,820 $1,485

Family of 2 $24,030 $2,003

Family of 3 $30,240 $2,520

Family of 4 $36,450 $3,038

Family of 5 $42,660 $3,555

Family of 6 $48,870 $4,073

Family of 7 $55,095 $4,591

Family of 8 $61,335 $5,111

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Each Maine hospital has its own application. You can get the application online on the hospital’s website. Or you can call the hospital and ask for patient billing. Say you want to sign up for free care. Ask them what it covers. After you get the application, fill it out and make yourself a copy. Then return it, but save your copy. They should send you an answer in a few weeks. You can do this after you have bills or sometimes before you get any. You can ask about free care/financial assistance at any point in the process. Some hospitals give bill discounts if your income is too high for free care. But that isn’t part of the law. If you want more information on what kind of hospital help you can get, call CAHC at 1-800-965-7476.

Community Health Centers There are many community health centers in Maine where you pay on a sliding scale for medical care. If you don’t have any income, or make very little, the cost is small. Almost everyone is eligible to receive health care at a community health center. They offer many kinds of help. You can be seen by doctors or nurse practitioners. You can get help with medicines. They have mental health services. You can go if you have MaineCare, Marketplace insurance, private insurance, or no insurance. To find a local health center near you, visit: http://www.mainecahc.org/guide-to-maine-health-care/ or call CAHC at 1-800-965-7476. Once you know where to go, call to make a new patient appointment. Some of the clinics offer dental care, too. There are also sliding fee dental clinics. You can find the list at http://www.mainecahc.org/guide-to-maine-health-care/.

MaineCare and Dental Benefits If you are under 21 and have MaineCare, your coverage includes benefits for preventive dental care as well as urgent dental care needs. It is very helpful to make sure you are set up as a patient at a dental practice that takes MaineCare before you turn 21 because MaineCare will cover your new patient appointment as well as routine cleaning, fillings, etc. After you turn 21, MaineCare only covers emergency dental care. If you aren’t already a patient at a dental practice when you turn 21 it can be hard to figure out where you can go. You may have to pay for a new patient appointment before you can get preventive care.

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Section 5: Getting Your Insurance to Pay Your Bills

Understanding the Explanation of Benefits or EOB After you get a service, you will get a bill. If you have insurance, you will also get an Explanation of Benefits (EOB). It will probably say, “This is not a bill.” Then what is it? It’s a statement from your insurance showing how it thinks the bill should be taken care of, who pays how much and why. The EOB shows: Basic information, like the date of service and name of your doctor or provider. If the service was covered by your plan. How much your insurance company paid, how much was counted towards your deductible,

how much you may have to pay out of pocket. The reason why the service was covered the way it was or the reason it wasn’t covered. This is

usually shown by a code of numbers or letters. You can find the meaning of these codes at the bottom of the page or the end of the EOB.

Different insurance companies use different styles and formats of EOBs. If you don’t understand your EOB, call your doctor’s office or the CAHC HelpLine at 1-800-965-7476. Here is one sample of an EOB showing the basic parts.

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“Allowed Amount”, or “Negotiated Rate” might also be called “Eligible Charges”: The amount your insurance company agreed your provider will be paid for a service. You may be responsible for paying some or all of this amount. You can find out what you owe by looking at your out of pocket cost amounts of your EOB.

The allowed amount is a discounted rate you get for being a member of your plan. If an in-network provider charges more for a service than the allowed amount, you can’t be billed for the difference. If you go out of network or if your service is denied, then your provider can bill you for the difference. This is called “balance billing.”

If the allowed amount for a service is $0.00, this means the service was denied by the insurance company and you're responsible for the full amount of the provider charges.

Provider Adjustment, Plan Discount, or Provider Responsibility: The difference between the provider charge and the allowed amount.

Service Information: A description and date of the service you received.

Date of Service Service Service Code

(CPT code) Provider Charges

Allowed Amount

Provider Adjustment Co-Pay Deductible Coinsurance Member

Responsibility Plan

Payment Reason Code(s)

3/7/16 Office Visit 99200 $120.00 $80.00 $40.00 $20.00 $0.00 $0.00 $20.00 $60.00 1

3/7/16 Laboratory 0300 $170.00 $110.00 $60.00 $0.00 $110.00 $0.00 $110.00 $0.00 2

3/7/16 X-ray 73600 $220.00 $0.00 $0.00 $0.00 $0.00 $0.00 $220.00 $0.00 3

Total: $510.00 $190.00 $100.00 $20.00 $110.00 $0.00 $350.00 $60.00

Reason Codes: 1: This is the member’s co-pay amount 2: This amount has been applied to the member’s deductible 3: Service is not covered because it did not receive prior-authorization See other side for more

<Sample>

This is Not a Bill

Patient: Tom Responsible Member ID: A0123456 Provider: Dr. Getwell Provider participation status: In- network Claim #: XY678910 EOB Date: 4/1/16

Provider Charges: The full amount your provider charged for a service.

Member Services: 1-234-567-8900 Fine Print Insurance Company 135 Rainy Day Way Somewhere, Maine 04123

Explanation of Benefits

Annual Individual In-Network Out of Pocket Limit

Annual Out of Pocket Limit $5,000

Deductible used - $1,070

Deductible remaining $3,930

$1,070 $3,930

$0 $5,000

Annual Individual In-Network Deductible

Annual Deductible $2,500

Deductible used - $950

$1550 Deductible remaining

$950 $1,550

$0 $2,500

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Date of Service Service Service Code

(CPT code) Provider Charges

Allowed Amount

Provider Adjustment Co-Pay Deductible Coinsurance Member

Responsibility Plan

Payment Reason Code(s)

3/7/16 Office Visit 99200 $120.00 $80.00 $40.00 $20.00 $0.00 $0.00 $20.00 $60.00 1

3/7/16 Laboratory 0300 $170.00 $110.00 $60.00 $0.00 $110.00 $0.00 $110.00 $0.00 2

3/7/16 X-ray 73600 $220.00 $0.00 $0.00 $0.00 $0.00 $0.00 $220.00 $0.00 3

Total: $510.00 $190.00 $100.00 $20.00 $110.00 $0.00 $350.00 $60.00

<Sample>

This is Not a Bill

Patient: Tom Responsible Member ID: A0123456 Provider: Dr. Getwell Provider participation status: In- network Claim #: XY678910 EOB Date: 4/1/16

Member Services: 1-234-567-8900 Fine Print Insurance Company 135 Rainy Day Way Somewhere, Maine 04123

Explanation of Benefits

Member Responsibility: The total amount of all out of pocket costs you’re responsible for. If a service was denied, you’ll also owe the full amount the provider charged or the ser-vice. This may or may not be included in the Member Responsibility amount on your EOB. *Some EOBs incorrectly list the member responsibility amount as $0.00 for denied ser-vices. If your EOB shows this amount as $0.00, check the reason code and the amount listed under “Allowed Charges” to find out if the service was denied.

Plan Payment: The amount your insurance company is responsible for.

Reason Code(s): Tell why a service was covered the way it was or why it was denied. The code is made up of numbers or letters. The code meanings are usually at the bottom of the EOB.

Out of Pocket Costs: The separate kinds of out of pocket costs you are responsible for.

Reason Codes: 1: This is the member’s co-pay amount 2: This amount has been applied to the member’s deductible 3: Service is not covered because it did not receive prior-authorization

Annual Individual In-Network Out of Pocket Limit

Annual Out of Pocket Limit $5,000

Deductible used - $1,070

Deductible remaining $3,930

$1,070 $3,930

$0 $5,000

Annual Individual In-Network Deductible

Annual Deductible $2,500

Deductible used - $950

$1550 Deductible remaining

$950 $1,550

$0 $2,500

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Cost Sharing and Private Insurance With private insurance, including health insurance through a job, you pay a monthly premium for membership. This gets you automatic discounts for any in-network services. Each provider in the company’s network has contracted or agreed on a certain rate. Without insurance, you’d pay more for that same exact service. With private insurance, there are several ways you may share the costs of care. One kind of cost sharing is co-pays. This is a fixed amount you pay directly to the heath care provider. It may be a small amount for a regular doctor visit and a much larger amount of money if you go to the Emergency Department. Most plans have a deductible. This is an amount you pay first before the insurance company begins to cover some of your health care bills. Deductibles can be from a few hundred dollars to thousands of dollars. Usually, the lower your monthly premium is, the higher the deductible. It’s a trade-off. If you have a $500 deductible, it means you pay the first $500 of bills. This is another kind of cost sharing. Co-insurance is yet another way cost-sharing is used by insurance companies. It means you pay a portion, percent, or fraction of the bill and the plan pays the other part. Maybe you pay 70% and the plan pays 30%. Or you pay 20% and the plan pays 80%. This begins after you meet your deductible. It continues until you reach your out-of-pocket maximum. Finally, Out-of-pocket maximum is a kind of safety net to cost sharing. Once you reach out-of-pocket maximum, the plan pays 100% of all your in-network, covered services, except your monthly premium. In summary: First you pay 100% of your medical bills, until you meet your deductible. Then you and the plan split the costs with you paying a co-insurance. You still pay all of your co-

pays. Then, when you hit your out-of-pocket maximum, the plan pays 100% of your medical bills.

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Free Preventive Care There is an exception to the cost sharing process. Preventive services are services that most people should get to help them stay healthy, like a flu shot or an annual checkup. The Affordable Care Act requires that all insurance plans, including MaineCare, cover preventive services at no charge and with no co-pays or co-insurance even if you haven’t met your deductible yet. To make best use of your plan, find out what services are free on your plan and make appointments for

those you feel would be helpful to you. There are separate lists of preventive services for children and

women. Here are a few examples of preventive services for adults covered with no charge by almost all

plans. There are many more. You can find a complete list here:

https://www.healthcare.gov/coverage/preventive-care-benefits/.

Tobacco use counseling Obesity screening and counseling Blood pressure screening Alcohol misuse screening and counseling Immunizations, like a flu shot Well woman visit or other annual screenings

Make Your Insurance Plan Work for You Here are tips to get the most value out of your insurance plan: Use only preferred or in-network providers. Make sure the services and medications you need are covered by your plan. Double-check with

your provider to be sure you will be in-network and the service is covered. Call the member services number or read your plan to find the answer.

Take advantage of all recommended free preventive services. Show your card when you get the service so the provider bills the correct plan. Read your insurance company handouts or handbook to see when you need permission or prior

authorization to get a service or medication. Then, get that permission to avoid bills. Call Member Services for your insurance company if you have a question or problem. Always

take a not on the date, time, who you spoke to and what was said. Ask to have answers mailed or emailed to you. Save these notes in a safe place.

Keep paying your premium it each month, even if you don’t use your insurance. Most MaineCare is free, but some kinds of MaineCare have monthly premiums.

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Tool: Making Your Insurance Plan Work for You Sometimes an insurance plan denies a service or medicine. This can happen after you had the service or got the medicine. It can also happen before you get the service or medicine, if it’s something your plan needs to give you an OK for ahead of time.

A third kind of problem is when you have a cost sharing amount or owe money for a service you think should count as preventive and should have been free.

In these cases, what should you do? If you need a medication or service the insurance plan refuses to

cover for you, you can appeal. Here is a short summary of steps for you, but you can find more detailed

information in this step-by-step appeal guide: http://www.mainecahc.org/wp-content-

cahc/uploads/2016/09/Appeal-Toolkit-CAHC2016.pdf.

Step Action Notes

Step 1 Become your own advocate. This

means developing arecord

keeping system.

Start a notebook and folder where you put all

related papers or mail. Keep a record of the

name of everyone you speak to, the date and

time of a call and carefully write down what

was said during the call. Save any emails from

any providers or insurance company staff in a

special folder.

Step 2 Check to see if you’ve met your

deductible yet.

The Estimate of Benefits (EOB) will tell you.

Step 3 Check to see if you still need to

pay co-insurance. This is when

you’ve met the deductible, but

not the out-of-pocket maximum.

If your plan paid part of the bill

but not all, this may be why.

The EOB will tell you.

Step 4 Check the Explanation of

Benefits and any denial letter to

see if the reason for non-payment

is a coding error.

Look at the bottom of the EOB for any

explanations of coding errors. If a coding

error is listed, call the medical staff that

referred you for the service. Explain the

problem and ask for their help resolving it.

Ask them to wait on payment while you solve

the problem.

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Step Action Notes

Step 5 Check the Explanation of

Benefits and any denial letter to

see if the reason for non-payment

is lack of information.

Look at the bottom of the EOB or in a denial

letter for a statement that not enough

information was given. If you see that, call

the medical staff that referred you for the

service, explain the problem and ask for their

help resolving it. Ask them to wait on

payment while you solve the problem.

Step 6 If you had preventive care that

should have been free, but you

were charged for it. Check with

your provider about why you

were charged.

Call the billing staff at the place your had the

service, explain the problem and ask for their

help resolving it. Ask if it should have been

coded differently so the insurance would

cover it as a preventive service.

Step 7 Delay payment. This allows time

for billing or coding errors to clear

up.

If you now owe a bill for a service you had, tell the billing staff at the place where you owe the bill that you are trying to get the service covered. Ask if they will wait for payment while you try to solve the problem.

Step 8 If none of these steps help, call

your health care provider.

If a reconsideration of your claim

is allowed in your case, it lets

your doctor explain over the

phone to the person who made

the denial, why you need or

needed the service.

Ask your healthcare provider to:

Double check that they used the right codes for your service

Send your insurance company all records & notes showing why you need or needed the service. If they already did this, ask them to resend it just in case the insurance company is missing some of the information.

Ask your insurance company and for a reconsideration or peer-to-peer call. This isn’t always available, but most plans allow this if the denial reason was: not medically necessary, experimental or investigational, out of network or excluded or not covered.

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Step Action Notes

Step 9 If none of these steps explain or

solve the problem, you may need

to appeal the decision.

If you live in Maine and the above steps have

not solved the problem, then call Consumers

for Affordable Health Care’s free and

confidential HelpLine at 1-800-965-7476.

Explain the problem and let them know the

steps you have taken. Ask for their help.

Perhaps you paid a bill but were eligible for MaineCare or hospital free care and didn’t know it in time.

Can you get your money back? In some cases, you can. If you already paid bills, but now you think it

should have been covered, try these steps:

Check if this

Applies to

You

Situation Step to Take

Did you have MaineCare when the

bill was incurred?

If MaineCare was supposed to pay, the

provider should bill MaineCare and then give

you your money back. You may need to check

every few weeks with your healthcare provider

to make sure this process is moving along. Were you eligible for MaineCare but

not actively enrolled?

If you get MaineCare within 3 months of the

bill, it can probably still be covered. If you

already paid, the provider should bill

MaineCare and give you your money back once

you are enrolled.

Were you eligible for hospital free

care but not signed up at the place

the bill was incurred?

If you are still eligible NOW, you should get

your money back. Call the hospital billing

department. Tell them you should have gotten

free care. Ask them to apply the bill to free

care. If you have paid some or all of a bill and it

gets approved for free care, ask the hospital

billing department how to request a refund of

the money you paid.

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Check if this

Applies to

You

Situation Step to Take

Has the bill already gone to

collections?

You will know the bill is in

collections when a debt collector

contacts you for payment on a

medical bill. This may be a

department within your healthcare

provider’s office or a separate

business that specializes in

collecting debts. The medical debt

will also probably be listed in your

credit report in the collections

sections.

You may need legal help to deal with this

situation. See Section 6 of this guide.

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Section 6. Medical Debt and Collections

Medical Debt If you do not pay your medical bills, you will end up with medical debt.

Tool: Dealing with Medical Debt If you have medical debt, consider the following:

Step Action

Step 1 Make sure you actually owe the money your health provider claims you owe. See the previous section on dealing with services you have been billed for but should have been covered by MaineCare or insurance.

Also, get an itemized bill. Check its accuracy. Find out how much this service would have cost in other places. If you are being charged way more, you can argue for less.

Step 2 Make a payment plan. Medical service providers will often be willing to set up a payment plan. You pay a set amount each month until the debt is paid off. You can try to negotiate the terms of this payment plan—the amount paid each month, interest amount, or fees. Be sure to get your agreement in writing.

Note: It is often better to make a payment plan directly with the provider rather than to pay a medical bill with a credit card. Most direct payment plans do not involve interest rates or fees unlike credit cards. Providers may also be more willing to negotiate a lower total payment over time.

Before making a payment plan, take some time to clarify what you can reasonably afford. Do not neglect essential costs of living to pay for your medical debt. Be sure you can cover the following first:

All expenses related to your job. This could include your car payment, gasoline to put into your car, and insurance or the cost of public transportation. It could also include the cost of childcare, uniform, and tools you need to do your work including your cell phone if it’s essential to your job.

The costs of your shelter including any utilities that you pay. The costs of basic necessities like food.

Obligations such as child support, income taxes, and student loan payments. Your wages could be garnished if you do not cover these other obligations.

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If step 2 is not an option, you can consider this.

Settle the debt. This means negotiating with your medical provider for a reduced overall balance that is considered full payment. Be aware that debt settlement comes with consequences. The unpaid balance could be counted as income. You could owe income taxes on the amount forgiven in debt settlement. If the balance is marked as “settled” on your credit reports, this may negatively affect your credit scores. It may also remain on your credit reports for up to 7 years. Be aware of debt settlement companies. They charge fees to settle debts on your behalf and often. Debt settlement scams are also common. If debt settlement is something you want to consider, talk directly with the medical provider’s billing office.

If step 2 is not an option, you can also consider this.

Consider bankruptcy. Bankruptcy is a process that helps people who can’t pay their debts. By selling their assets to pay their debts or creating repayment plans, bankruptcy provides relief to individuals overwhelmed by their debts. Like debt settlement, bankruptcy has some lasting consequences: A bankruptcy will be reported on your credit reports for up to 10 years. This

is seen as negative. Your credit scores will be negatively affected by bankruptcy. You cannot file for bankruptcy again for many years.

If bankruptcy is something you want consider, get legal help. Start with Pine Tree Legal Assistance at ptla.org/bankruptcy-maine

Get additional assistance

Work with a Consumer Credit Counseling Services. This network of notprofit organizations that can help you choose the right course of debt repayment. In Maine, you can contact:

Money Management International – Bangor office 175 Exchange St., Ste. 200 Appointment #: 1-866-346-2227 www.moneymanagement.org Money Management International – Portland office 477 Congress St., 5th Fl. Appointment #: 1-866-346-2227 www.moneymanagement.org

For additional options, visit https://www.nfcc.org/locator/.

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You can also get assistance from Pine Tree Legal Assistance at http://ptla.org/triage/me_triage

Dealing with Medical Debt in Collections If you do not pay the debt that builds up with a medical provider, your health care provider may send

that medical debt to collections. This can be a department within your medical provider’s office or it

can be a different business that specializes in debt collection.

Businesses that specialize in debt collection are often called third party debt collectors. There are

special laws that say what third party debt collectors can and cannot do in trying to get you to pay a

debt that has gone to collections. This section will go over how to deal with a medical debt in

collection as well as your rights in collections.

Judgment or Collection Proof Judgment or collection proof means that even if a creditor sues you, you do not have enough income or assets to pay them. With income, it means your income is very low or it comes from a protected source: unemployment, Social Security, Supplement Security Income, public assistance, child support, Veteran’s benefits, or federal and civil service retirement benefits. Assets are things that you own that have value. If you are judgment or collection proof, it means you do not have any assets above or beyond those that are exempt or protected from collection.

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Tool: Dealing with Medical Debt in Collections If a debt has gone to collections, use this checklist to make sure you are:

Paying what you truly owe, and

Sending payment only to someone who can legitimately collect the debt.

Check

When

Complete

Step Additional Information

Do not ignore contact from a

debt collector. They can

contact you by phone or

through the mail.

There is certain information the debt collector must share with you by law during the initial contact or within 5 days of the initial contact: The amount of the debt you owe. The name of the creditor you owe the debt to. That you have 30 days to dispute the validity

of the debt.

That if you do not dispute the validity of the debt, it

will be assumed as valid.

If you do not recognize the

debt, question the amount of

the debt, or question the right

of the debt collector to collect

this debt from you, send a

debt validation letter. This is

also called a debt verification

letter.

If you send this letter within 30 days of being contacted by a debt collector, they must stop all debt collection efforts. They cannot start debt collection efforts until they send verification of the debt to you. They also can’t report this debt to Equifax, Experian, or TransUnion. If they do, this is a Fair Credit Reporting Act Violation and you can sue them. There is no time limit for the debt collector to

respond.

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Use the example letters from the Consumer Financial Protection bureau (below) to send a letter if: You believe you do

not owe the debt. You want more

information about the debt (question the amount or the debt collector’s authority to collect the debt)

Send these letters Certified Mail, Return Receipt Requested. This costs a little extra money at the post office, but you will get a receipt in the mail when the debt collector has received your letter. This is PROOF of your dispute and that they received your letter.

Save a copy of your letter and the receipt.

If the debt collector responds with a notice to sue you, get legal help. Never, ever ignore a

creditor’s notice of a lawsuit

even if you believe or know

you are judgment or

collection proof.

Immediately contact Pine Tree Legal Assistance at http://ptla.org

or 207-774-8211.

Understand the statute of limitations for how long the debt can be collected.

In Maine, a health care provider or debt collector has 6 years from the time you stopped paying on the debt to collect payment after you. Be aware the debt collection efforts may intensify as you get close to the 6-year mark for a debt. This could include a notice to sue you. Be sure not to do anything that would “restart the clock” on your debt. Specifically: Do not send in a small payment. Do not acknowledge you owe the debt.

Never ignore a notice of a lawsuit. Immediately contact Pine Tree

Legal Services at www.ptla.org or 207-774-8211.

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Understand the Fair Credit Reporting Act limits to how long negative information can be reported.

A debt can only be reported for 7 and one half years. The starting time for the 7.5 years for the reporting of a debt starts from the month before you stopped paying for the ORIGINAL DEBT regularly no matter who owns the debt now.

If you know that you owe the debt, know the debt collector is legitimate, still have many years left on the statute of limitations, and want to pay the debt, make a plan to pay.

You may be able to: Set up a payment plan with the debt collector. Make sure

it’s a plan you can afford. Negotiate a lower balance that is considered payment in

full. Ask that the account be noted as paid in full on your credit report, not settled.

Make a lump sum payment if you have the resources. In general, focus on new debts in collections. Old debts in collections have already done maximum damage to your credit history and scores, and may be getting close to the 6 year statute of limitations or the 7.5 year credit reporting limiting.

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Sample Letter: Debt collector response when you believe you do not owe the debt. 3 [Your name] [Your return address] [Date] [Debt collector name] [Debt collector address] Re: [Account number for the debt, if you have it] Dear [Debt collector name], I am responding to your contact about collecting a debt. You contacted me by [phone/mail], on [date] and identified the debt as [any information they gave you about the debt]. I do not have any responsibility for the debt you’re trying to collect. If you have good reason to believe that I am responsible for this debt, mail me the documents that make you believe that. Stop all other communication with me and with this address, and record that I dispute having any obligation for this debt. If you stop your collection of this debt, and forward or return it to another company, please indicate to them that it is disputed. If you report it to a credit bureau (or have already done so), also report that the debt is disputed. Thank you for your cooperation. Sincerely, [Your name]

3 Consumer Financial Protection Bureau: consumerfinance.gov

Fill in your

information.

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Sample Letter: Debt collector response when you question the debt or want more information about it. 4 [Your name] [Your return address] [Date] [Debt collector name] [Debt collector Address] Re: [Account number for the debt, if you have it] Dear [Debt collector name]: I am responding to your contact about a debt you are trying to collect. You contacted me by [phone/mail], on [date] and identified the debt as [any information they gave you about the debt]. Please supply the information below so that I can be fully informed: Why you think I owe the debt and to whom I owe it, including: The name and address of the creditor to whom the debt is currently owed, the account number

used by that creditor, and the amount owed. If this debt started with a different creditor, provide the name and address of the original

creditor, the account number used by that creditor, and the amount owed to that creditor at the time it was transferred. When you identify the original creditor, please provide any other name by which I might know them, if that is different from the official name. In addition, tell me when the current creditor obtained the debt and who the current creditor obtained it from.

Provide verification and documentation that there is a valid basis for claiming that I am required to pay the debt to the current creditor. For example, can you provide a copy of the written agreement that created my original requirement to pay?

If you are asking that I pay a debt that somebody else is or was required to pay, identify that person. Provide verification and documentation about why this is a debt that I am required to pay.

The amount and age of the debt, including: A copy of the last billing statement sent to me by the original creditor. State the amount of the debt when you obtained it, and when that was. If there have been any additional interest, fees or charges added since the last billing statement

from the original creditor, provide an itemization showing the dates and amount of each added amount. In addition, explain how the added interest, fees or other charges are expressly authorized by the agreement creating the debt or are permitted by law.

If there have been any payments or other reductions since the last billing statement from the

4 Consumer Financial Protection Bureau: consumerfinance.gov

Fill in your

information.

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original creditor, provide an itemization showing the dates and amount of each of them. If there have been any other changes or adjustments since the last billing statement from the

original creditor, please provide full verification and documentation of the amount you are trying to collect. Explain how that amount was calculated. In addition, explain how the other changes or adjustments are expressly authorized by the agreement creating the debt or permitted by law.

Tell me when the creditor claims this debt became due and when it became delinquent. Identify the date of the last payment made on this account. Have you made a determination that this debt is within the statute of limitations applicable to

it? Tell me when you think the statute of limitations expires for this debt, and how you determined that.

Details about your authority to collect this debt.

I would like more information about your firm before I discuss the debt with you. Does your

firm have a debt collection license from my state? If not, say why not. If so, provide the date of the license, the name on the license, the license number, and the name, address and telephone number of the state agency issuing the license.

If you are contacting me from a place outside my state, does your firm have a debt collection license from that place? If so, provide the date of the license, the name on the license, the license number, and the name, address and telephone number of the state agency issuing the license.

I have asked for this information because I have some questions. I need to hear from you to make an informed decision about your claim that I owe this money. I am open to communicating with you for this purpose. In order to make sure that I am not put at any disadvantage, in the meantime please treat this debt as being in dispute and under discussion between us. In addition to providing the information requested above, please let me know whether you are prepared to accept less than the balance you are claiming is owed. If so, please tell me in writing your offer with the amount you will accept to fully resolve the account. Thank your cooperation. Sincerely, [Your name]

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You Have Rights in Debt Collection

The Fair Debt Collection Practices Act protects you from unfair practices when it comes to debt

collections. This law only applies to personal, household, or family debts including medical debt. It

also only applies to third party debt collectors. These are businesses that regularly collect debts. They

can be collection agencies or attorneys that regularly collect debts on for businesses.

Following is a checklist of your rights when it comes to debt collections.

A debt collector cannot contact you before 8:00 a.m. or after 9:00 p.m.

A debt collector cannot contact you in a place that is inconvenient unless you have given them

permission to.

A debt collector cannot contact you where you work if the collector has reason to believe your

employer does not allow it.

A debt collector cannot contact anyone else when trying to collect a debt from you EXCEPT:

you, your attorney, a consumer reporting agency, the creditor, the creditor’s attorney, or the

debt collector’s attorney.

A debt collector must provide you with certain basic information including:

• The amount of the debt

• The name of the creditor you owe the debt to

• Notice that you have 30 days to dispute the debt before it is assumed to be a valid debt

• Notice that if you do dispute the debt, that the debt collector will send verification of

the debt or the copy of a judgment

When a debt collector tries to collect a debt, they may not harass or abuse you. Specifically, a debt

collector may not:

Use or threaten to use violence or any other means to harm you including your reputation or

property

Use obscene, profane or abusive language

Publish lists of individuals that refuse to pay their debts. They can, however, report you to a

consumer-reporting agency.

Annoy, abuse, or harass you by repeatedly calling you

State or imply that nonpayment will results in arrest or imprisonment

Take, or state that they will take, an asset or garnish your bank account or wages unless they

are permitted by law to do this

Falsely claim:

• They are attorneys or representations of the government

• You have committed a crime.

• They work for a credit-reporting agency.

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Additionally, debt collectors are not allowed to give false information about you to anyone include

credit-reporting agencies.

Finally, debt collectors are prohibited from using unfair practices. These include:

Collecting additional money on top of what you owe unless the contract that created the debt or

your state law allows additional interest or fees to be charged.

Depositing a post-dated check early.

Contacting you using a postcard.

If you believe a debt collector has violated any of your rights, get legal assistance immediately. Start by

contacting Pine Tree Legal Assistance at www.ptla.org or 207-774-8211.

Property Exempt from Debt Collection in Maine 1. Equity in your home up to $47,500. This exemption increases to $95,000 if:

• a minor dependent lives with you, or • you or are at least 60 years old or disabled, or • you have a dependent that is at least 60 years old or disabled.

If you don’t own a home, you can apply this exemption to a burial plot.

2. Equity in one vehicle up to $5,000.

3. Equity in “tools of the trade” of up to $5,000.

4. Your clothing up to $200 in value for each item.

5. Equity in household furniture, appliances, and other household goods up to $200 for each item.

6. Jewelry up to $750 in total value, and your wedding and engagement rings.

7. Life insurance contracts (and up to $4000 in any accrued dividends, interest, or loan value in such contracts).

8. Certain farm equipment if you are a farmer.

9. A fishing boat if you fish commercially.

10. Certain amounts of heating fuel and cordwood.

11. Your furnace, heating stoves and one cook stove.

12. Prescribed health aids.

13. A supply of food, seed, and gardening tools.

14. A few other specific protections also apply.

Source: Pine Tree Legal Assistance

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Section 7: Medical Debt and Credit Reports and Scores One in three Americans have their credit

affected by medical debt.5 When medical

debt goes to collections, it is a negative

entry on your credit reports and makes

your credit scores drop.

There are three major credit-reporting agencies: Equifax, Experian, and TransUnion. They collect data about how people pay some of their bills, debts, and obligations. This information documented in credit reports. Credit scores are numbers based on information contained in credit reports. You have many different scores based on different scoring models, but FICO scores are the most commonly used. A wide range of businesses and organizations make decisions about you based on both credit reports and scores: Banks, credit unions, and other lenders use credit reports and scores to decide whether you will get a loan and how much you will pay in interest and fees on the loan. Banks and credit unions are also increasingly using credit reports to help determine whether you will be able to open a savings or checking account. Credit card issuers use credit reports and scores to determine whether your application for a credit card will be approved and the rate you will pay for money borrowed through a credit card.

5 “Five things you need to know about medical bills on your credit report” by Lacie Glover. U.S. News and World Report—Healthcare. 10/2/2014

What’s in a Credit Report?

While each three major nationwide credit-reporting agencies—Equifax, Experian, and TransUnion—have their own report formats, these reports have five sections in common: Identifying information. This section includes your name, aliases, Social Security number, addresses, phone numbers, and work history. It includes information that alone or in combination can establish your identity. Public records. This is information from the courts of a financial nature and can include bankruptcies, tax liens, judgments, orders related to child support, and so on. Collection accounts. This section includes debts that have been charged off by the original creditor and consigned or sold to collection agencies. Trade line or account information. This section includes information about open and closed accounts such as account numbers, type of account, balances owed, and payment history. Inquiries. This section includes a record of your applications for credit as well as review of your credit by businesses for offers of credit.

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Landlords will review your credit reports and scores to decide whether they will rent to

you and how much you will have to pay in security deposits.

Utility companies will use credit reports and scores to determine the size of your deposits. Other service providers like cell phone companies will use credit reports and score determine

the plan you qualify for and other potential fees and deposits. Insurance companies in some states use them to determine coverage and rates. Employers use credit reports to determine whether you get an interview, a job, a promotion once you have a job, or security clearance depending on the type of job you have. Rules about when employers can or cannot use credit reports vary from state to state.

Having positive credit reports and high scores can open doors. Products and services also cost less when you have good credit. Luckily, there have been some changes related to medical debt on reports and in one scoring model.

Credit Reports Equifax, Experian, and TransUnion are the three major nationwide credit reporting agencies. All three have recently implemented a policy requiring a 180-day waiting period before including medical debt on a credit report. The waiting period provides extra time to resolve late payments on medical bills or debts due to delays in payment from or disputes with insurance providers. There is often a gap between when someone is billed and when insurance companies pay claims. Too often, this gap results in a medical bill being sent on to collections. This new policy should lessen the frequency of medical debt being reported on credit reports because of this gap. Once a medical debt is paid, it will be removed from the credit report; it will not stay on the report for the typical seven-year period. 6 You can get one free credit report each year from each of the three agencies. Instructions for how to get a credit report can be found in the Medical Debt and Credit Tool on the next page.

Credit Scores Based on this new policy, people may see their credit scores improve because credit scores are based on the information in credit reports. Debts that were formerly added to credit reports will be delayed and potentially never show up on credit reports. Additionally, FICO has made adjustments to its version 9 scoring model because medical debts are almost always the result of an unplanned event and medical bills are “especially susceptible to erroneous reporting.” Common problems include: Errors in insurance claims processing Errors in or denials of coverage due to incorrect coding of services provided Undocumented payment arrangements Double billing for the same procedure

6 “A major overhaul in credit reporting could improve your credit score” by Danielle Douglas-Gabriel. Washington Post. 3/9/2015.

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As a result, medical debt that was in collections, but was eventually paid off will not factor into the FICO 9 score. Outstanding medical debts, will still affect scores, but their overall impact will be less.7, 8 The challenge for individuals is that many versions of the FICO scoring model are still used and the improvements in treatment of medical debts apply only to the FICO 9 scoring model.

Tool: Medical Debt and Credit Use the following checklist to help a young person get, review, and fix their credit reports related to medical debt. You will note that there is no instruction on getting credit scores. Because scores are based primarily on credit reports, understanding and action should be focused on the reviewing and fixing credit reports.

Check when completed Action Step

Ask the young person: Are you concerned about your credit reports and scores? If yes, get and review the credit reports. If no, use the information at the beginning of this section to explain the importance of good credit. Then move on to the next step.

Get the young person’s credit report. There are three options for getting credit reports from Annual Credit Report.com. Most people find using the mail-in form the easiest method, and Pine Tree Legal advises that this is the best way to do it. You can use the same form for all three credit reporting agencies. The form included right after this tool. Through the mail. Print the online form (also found after this tool) https://www.annualcreditreport.com/manualRequestForm.action and send it in per the instructions to: Annual Credit Report Request Service P.O. Box 105281 Atlanta, GA 30348-5281 The reports will be sent to you via mail.

7 http://www.fico.com/en/blogs/risk-compliance/impact-medical-debt-fico-scores/. Accessed 7/31/16. 8 http://www.myfico.com/crediteducation/fico-score-versions.aspx. Accessed 7/31/16.

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Online. Complete the information required at: https://www.annualcreditreport.com/index.action. Ensure you are on a secure Internet connection (not a public computer). You will be able to print the reports or save them to your computer as a PDF file. If the young person is unable to answer the security questions, which are based on information in the reports, you will have to get the reports by mail or phone request. By phone. Call 877-322-8228 to get the reports. The reports will be sent to you by mail. Please note that there are three different credit reports to request:

1. Equifax 2. Experian 3. TransUnion

If reviewing credit for the first time, it may be beneficial to request all three at one time. It is essential to look at all three credit reports because a provider may report some information to only one of the three credit reporting agencies. In the future, good practice involves ordering one of three every four months. For example, get the: Experian credit report in January Equifax credit report in May TransUnion credit report in September

This can help spot errors faster and potential identity theft, too.

Review each credit report. Check if correct. Is the name listed and spelled correctly? Is the social security number correct? Is the date of birth correct? Are all of the addresses listed correct? Is the information listed in the public records section accurate? Is the information listed in the collection account section

accurate?

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Be sure to check for anything related to medical care or medical debts.

Be sure to check that debt listed in the collection section have zero balances in the trade line or account information section.

Is the information listed in the trade line or account information section accurate?

Be sure to check to anything that may not belong to the young person.

If there are medical debts listed, follow the action steps below. For anything that is not correct, following the action steps for disputes.

Follow up for any medical debts listed in the trade line or account information section. If a medical debt is listed in the trade line or account information section, call the credit-reporting agency to find out whether the 180-day waiting period was observed. Find out the start date of the 180-day waiting period. If the 180-day waiting period was not observed, file a dispute (see below). If the charge listed is one that should have been covered by Medicaid, Medicare, State Insurance, or private insurance, file a dispute with the Credit Reporting Agency explaining this. Be sure to provide COPIES of any evidence to support your claim. See the action step below on filing a dispute.

Follow up for any medical debts listed in the collection section of the credit reports. If the medical collection account was paid, file a dispute with the credit-reporting agency to have the information removed. If the medical collection account has not been paid and you are not sure you owe the debt, request a debt verification from the collection agency. See the Sample Debt Verification Letter following this checklist. By law, any debt collector that contacts you claiming you owe payment must tell you: The name of the original creditor The amount you owe How to dispute the debt or seek verification of the debt

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File a dispute for any information that is incorrect or out of date. Complete the dispute form (links provided below), write a letter

to the credit-reporting agency or do both. Report the incorrect or out of date information using the example letter following this checklist.

Circle the incorrect or out-of-date information on a copy of your

credit report and include it with the letter. If evidence is needed, make copies of this evidence. This could

include a receipt of payment, copies of cancelled checks, electronic verification of payment, and so on. Never send any original documents. Attach the copies of your evidence to your letter.

Send the completed form or letter, copies of the evidence, and

the credit report with the incorrect or out of date information circled to the appropriate credit reporting agency certified mail, return receipt requested. When the credit reporting agency gets your dispute in the mail, you will get a receipt back in the mail. This gives you evidence your dispute was received and the date it was received on.

• Contact Pine Tree Legal Asistance for advice about your particular situation. 1-207-774-8211 or http://ptla.org/bankruptcy-maine.

To file a dispute with each credit reporting agency: Equifax Online: www.ai.equifax.com/CreditInvestigation By mail: Use the dispute form, which can be found at http://www.equifax.com/cp/MailInDislcosureRequest.pdf Mail the dispute form with your letter to: Equifax Information Services LLC P.O. Box 740256 Atlanta, GA 30374 By phone: Phone number provided on credit report or 800-864-2978

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Experian Online: www.experian.com/disputes/main.html By mail: Use the address provided on your credit report or mail your letter to: Experian P.O. Box 4000 Allen, TX 75013 By phone: Phone number provided on credit report or 888-397-3742 TransUnion Online: www.transunion.com/personal-credit/credit-disputes-alerts-freezes.page By mail: Use the dispute form, which can be found at http://www.transunion.com/docs/rev/personal/InvestigationRequest.pdf to download the dispute form. Mail the dispute form with your letter to: TransUnion Consumer Solutions P.O. Box 2000 Chester, PA 19016 By phone: 800-916-8800 The credit reporting agencies has 30 days to have the entry verified by the information provider. If the entry cannot be verified, it must be removed from the credit report. You will have to check periodically to ensure the information that was removed does not creep back onto your report, however.

When it comes to taking care of your credit history, you have rights. But you also have a responsibility to remain vigilant. Check your credit reports at least one time per year. Dispute incorrect or out of date information. This will not only improve your credit reports, but it will also improve your credit scores.

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Sample Debt Verification Letter9

Use this letter as a guide if you have a debt in collections that you do not recognize or where you think the information including the balance owed is incorrect. Be sure to retype the letter and fill it in with your information. [Your name] [Your return address] [Date] [Debt collector name] [Debt collector address] Re: [Account number for the debt, if you have it] Dear [Debt collector name]: I am responding to your contact about a debt you are trying to collect. You contacted me by [phone/mail], on [date] and identified the debt as [any information they gave you about the debt]. Please supply the information below so that I can be fully informed: Why you think I owe the debt and to whom I owe it, including: The name and address of the creditor to whom the debt is currently owed, the account

number used by that creditor, and the amount owed. If this debt started with a different creditor, provide the name and address of the original

creditor, the account number used by that creditor, and the amount owed to that creditor at the time it was transferred. When you identify the original creditor, please provide any other name by which I might know them, if that is different from the official name. In addition, tell me when the current creditor obtained the debt and who the current creditor obtained it from.

Provide verification and documentation that there is a valid basis for claiming that I am required to pay the debt to the current creditor. For example, can you provide a copy of the written agreement that created my original requirement to pay?

If you are asking that I pay a debt that somebody else is or was required to pay, identify that person. Provide verification and documentation about why this is a debt that I am required to pay.

The amount and age of the debt, including: A copy of the last billing statement sent to me by the original creditor. State the amount of the debt when you obtained it, and when that was.

9 Consumer Financial Protection Bureau, consumerfinance.gov

Fill in your

information.

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If there have been any additional interest, fees or charges added since the last billing statement from the original creditor, provide an itemization showing the dates and amount of each added amount. In addition, explain how the added interest, fees or other charges are expressly authorized by the agreement creating the debt or are permitted by law.

If there have been any payments or other reductions since the last billing statement from the original creditor, provide an itemization showing the dates and amount of each of them.

If there have been any other changes or adjustments since the last billing statement from the original creditor, please provide full verification and documentation of the amount you are trying to collect. Explain how that amount was calculated. In addition, explain how the other changes or adjustments are expressly authorized by the agreement creating the debt or permitted by law.

Tell me when the creditor claims this debt became due and when it became delinquent. Identify the date of the last payment made on this account. Have you made a determination that this debt is within the statute of limitations

applicable to it? Tell me when you think the statute of limitations expires for this debt, and how you determined that.

Details about your authority to collect this debt. I would like more information about your firm before I discuss the debt with you. Does your

firm have a debt collection license from my state? If not, say why not. If so, provide the date of the license, the name on the license, the license number, and the name, address and telephone number of the state agency issuing the license.

If you are contacting me from a place outside my state, does your firm have a debt collection license from that place? If so, provide the date of the license, the name on the license, the license number, and the name, address and telephone number of the state agency issuing the license.

I have asked for this information because I have some questions. I need to hear from you to make an informed decision about your claim that I owe this money. I am open to communicating with you for this purpose. In order to make sure that I am not put at any disadvantage, in the meantime please treat this debt as being in dispute and under discussion between us. In addition to providing the information requested above, please let me know whether you are prepared to accept less than the balance you are claiming is owed. If so, please tell me in writing your offer with the amount you will accept to fully resolve the account. Thank you for your cooperation. Sincerely, [Your name]

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Sample Credit Report Dispute Letter10

Use this letter as a guide in writing your own dispute letter to the credit reporting agency that has reported incorrect or out of date information on your credit report. Be sure to retype the letter and fill it in with your information. Your Name] [Your Address] [Your City, State, Zip Code] [Date] Complaint Department [Company Name] [Street Address] [City, State, Zip Code] I am writing to dispute the following information that your company provided to [give the name of the credit reporting company whose report has incorrect information]. I have circled the items I dispute on the attached copy of the credit report I received. This item [identify item(s) disputed by type of item, such as credit account, judgment, etc., and your account number or another method for the information provider to locate your account] is [inaccurate or incomplete] because [describe what is inaccurate or incomplete and why]. I am requesting that [name of company] have the item(s) removed [or request another specific change] to correct the information. Enclosed are copies of [use this sentence if applicable and describe any enclosed documents, such as payment records and court documents] supporting my position. Please reinvestigate this [these] matter[s] and contact the national credit reporting companies to which you provided this information to have them [delete or correct] the disputed item[s] as soon as possible. Sincerely, Your name Enclosures: [List what you are enclosing.]

10 Federal Trade Commission, ftc.gov

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Section 8:

Closing Good health and good sense are two of life's greatest blessings. -Publilius Syrus

Good health comes with access to health care. Unfortunately, many young people who have been in foster care in Maine do not access health care because they do not have healthcare coverage and do not know they are likely eligible for MaineCare coverage. Additionally, those who have interacted with the health care system may find themselves burdened with bills or even worse, medical debt because they were not able to pay their bills. In many cases, young people who were in the foster care system should not have to pay for these bills. Sadly, medical bills and debts not only create stress, but also lead to negative entries on credit reports and poor credit scores. Poor credit histories and scores can create barriers to accessing credit, services such as cell phone plans, insurance, apartments, and even jobs. This Guide was intended to help allies of young people in or who have been in foster care address these complex issues related to accessing and paying for health care. The healthcare system should be supporting these young people to maintain their physical and mental health without jeopardizing their financial health. The information contained within this guide is for educational purposes. The information and tools also do not constitute legal interpretation or advice on the part of the individuals involved or the organizations for which they work. Through the assistance provided by professional staff, volunteers, or other caring adults using this guide, issues related to accessing and paying for appropriate healthcare can be solved. Thank you for the important role you play in helping young people dal with the challenges of navigating health insurance, medical bills and debt.

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Section 9: Getting More Help – Who to Contact

If your question is like: Then call:

Can I get MaineCare? CAHC HelpLine: 1-800-965-7476

Can I get hospital free care? CAHC HelpLine: 1-800-965-7476

Can I get a Marketplace plan? CAHC HelpLine: 1-800-965-7476

How do I pick a Marketplace plan? CAHC HelpLine: 1-800-965-7476

Why did I lose MaineCare? CAHC HelpLine: 1-800-965-7476

Why did I lose my Marketplace plan? CAHC HelpLine: 1-800-965-7476

Why didn’t my insurance cover my bill?

CAHC HelpLine: 1-800-965-7476

What do I do about a bill sent to collections?

Pine Tree Legal Assistance at www.ptla.org or 1-207-774-

8211.

I’m being sued for payment by a medical provider or debt collection. What can I do?

Pine Tree Legal Assistance at www.ptla.org or 1-207-774-

8211.

I’m being unfairly evicted- help? Pine Tree Legal Assistance at www.ptla.org or 1-207-774-

8211.

Why did I lose Food Supplement (SNAP) benefits?

MEJP: 1-866-626-7059

Any other help for us in the “coverage gap”?

1. Call 211 2. Maine Primary Care Association – find a Community Health Center near you; mepca.org/findlocalhelp 3. CarePartners: 1-877-626-1684 (certain counties only)

I can’t afford my medicines! MedAccess: 1-877-275-1787

I need help setting up a payment plan with a medical provider or debt collector.

Money Management International

175 Exchange St., Ste. 200 Bangor, ME 04401 Appointment #: (866) 346-2227 www.moneymanagement.org 477 Congress St., 5th Fl.

Portland, ME 04101

Appointment #: 1-866-346-2227

www.moneymanagement.org

For additional options, visit www.nfcc.org/locator/.

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I want to explore debt settlement or bankruptcy.

Pine Tree Legal Assistance at www.ptla.org or 1-207-774-

8211.

Money Management International

175 Exchange St., Ste. 200

Bangor, ME 04401

Appointment #: 1-866-346-2227

www.moneymanagement.org

477 Congress St., 5th Fl.

Portland, ME 04101

Appointment #: 1-866-346-2227

www.moneymanagement.org

For additional options, visit www.nfcc.org/locator/.

I think a debt collector has violated my rights.

Pine Tree Legal Assistance at www.ptla.org or 1-207-774-

8211.

I think a debt is being reported on my credit report for more than the allowable time.

Pine Tree Legal Assistance at www.ptla.org or 1-207-774-8211. Money Management International 175 Exchange St., Ste. 200 Bangor, ME 04401 Appointment #: 1-866-346-2227 www.moneymanagement.org Money Management International 477 Congress St., 5th Fl. Portland, ME 04101 Appointment #: 1-866-346-2227 www.moneymanagement.org For additional options, visit www.nfcc.org/locator/.

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Section 10: Acknowledgments This guide was created to provide a resource for adult partners who provide assistance to young people in Maine who are or have been in foster care. The guide was conceptualized and edited by Becca Matusovich (USM’s Muskie School/Cutler Institute) and was written by Inger Giuffrida (Financial Education and Asset Building Consultant) and Mary Schneckenburger (Consumers for Affordable Healthcare). We are grateful for the input and feedback from many other partners who reviewed drafts:

Kera Pingree and Jessica Harris, Youth Leaders Pamela Goodwin, DHHS Youth Transition Worker Frank D’Allessandro, Pine Tree Legal Assistance Jessica Curtis, Community Catalyst Crystal Castro, Susan Pate, and Erica Sawyer, USM’s Muskie School/Cutler Institute

The development of this guide was made possible with funding from the Jim Casey Youth Opportunities Initiative. The information contained within this guide is for educational purposes. The information and tools also do not constitute legal interpretation or advice on the part of the individuals involved or the organizations for which they work.

This guide is being launched in October 2016 as a “FieldTest Version” in order to test its value and usability in the field. We appreciate feedback about how it works in practice to use the guide and whether it contains the information most needed to assist young people dealing with medical bills and debts. Please use this survey on our website to provide your feedback: www.maine-ytc.org/navigating-medical-bills-debt/

Questions or comments: contact Becca Matusovich at bmatusovich@maine.edu or 1-207-780-4865.

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About the Maine Youth Transition Collaborative (MYTC) MYTC is a network of youth leaders and public and private partners from across Maine, working together to ensure that youth transitioning from the foster care system to adulthood have the resources and personal connections they need to be successful. MYTC coordinates collaborative strategies involving community and state partners to address gaps and issues vital to a young person’s social & emotional well-being, intellectual development, economic success, and health and safety. www.maine-ytc.org

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About the Cutler Institute, University of Southern Maine The Cutler Institute at USM’s Muskie School of Public Service is dedicated to developing innovative, evidence-informed, and practical approaches to pressing health and social challenges faced by individuals, families, and communities. The Cutler Institute’s Children, Youth, and Families Program advances the well-being of children and families by improving the public and private systems that serve them. We work to include the voices of children, youth and families, and to engage community. Our approach empowers and strengthens the clients we serve. We have earned a national reputation for excellence in research, policy development, program evaluation, training, and technical assistance. www.usm.maine.edu/muskie/cutler/overview www.yceme.org/ About Consumers for Affordable Health Care (CAHC) Consumers for Affordable Health Care is a Maine advocacy organization that strives to ensure a strong consumer voice in Maine’s health system. We provide resources to educate consumers and assist them in navigating the existing system. We also work with systems such as insurance companies, DHHS, the legislature, and hospitals to move health care access and justice forward in Maine. For almost 3 decades, CAHC (rhymes with “cake”) has been working to help all Mainers get the care they need. Thousands of Mainers over the years have called our Helpline (1-800-965-7476) and gotten answers and help solving coverage problems. Give us a call! www.mainecahc.org/ About Inger Giuffrida For the past 18 years, Inger Giuffrida has provided technical assistance and delivered training and financial education “training for trainers” to thousands of practitioners in the asset-building and financial capability fields across the United States and Canada and is often a keynote speaker or featured trainer at conferences. She developed the Consumer Financial Protection Bureau’s Your Money, Your Goals toolkit and training series called as well as the Jim Casey Youth Opportunities Initiative’s financial capability curriculum, Keys to Your Financial Future.

About Pine Tree Legal Assistance (PTLA) PTLA is a statewide, non-profit organization committed to providing high quality, free, civil legal assistance to low-income people in Maine. PTLA’s mission is to ensure that state and federal laws affecting poor people are enforced while also addressing the systemic barriers to justice that low-income Mainers face. We are committed to ensuring that all Mainers have access to justice. http://ptla.org/ About the Jim Casey Youth Opportunities Initiative (JCYOI) JCYOI is a national and state-based effort that believes every young person leaving foster care should have the family connections, opportunities and support needed for a successful transition to adulthood. As part of the Annie E. Casey Foundation and in partnership with other investors, the Jim Casey Youth Opportunities Initiative is active in states and local communities across the nation to increase opportunities for young people who are in or transitioning from foster care. Maine has been a JCOYI site since 2003. www.aecf.org/work/child-welfare/jim-casey-youth-opportunities-initiative

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NON-DISCRIMINATION NOTICE In complying with the letter and spirit of applicable laws and in pursuing its own goals of diversity, the University of Maine System shall not discriminate on the grounds of race, color, religion, sex, sexual orientation, national origin or citizenship status, age, disability, or veteran’s status in employment, education, and all other areas of the University. The University provides reasonable accommodations to qualified individuals with disabilities upon request. Questions and complaints about discrimination in any area of the University should be directed to the executive director, Office of Campus Diversity and Equity, 780-5094, TTY 780-5646.

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