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Maine Guide for Health Care and Insurance Resources

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Mission statement: We are a small group of students interested in making the often stressful trip to get medical attention more streamlined and user-friendly. In this document we have collected vital information that may be of use to both patients and healthcare professionals. We welcome feedback! Feel free to contact us with critiques at nicolas.mesloh@maine.edu.

Table of Contents: Page

1-3 Resources for domestic violence, Free clinics, and services in Maine.

3-5 Resources for people experiencing homelessness. 6 Resources for mothers, or expectant mothers.

7 Resources for people seeking treatment for substance abuse. 8 Resources for people who need nutrition, and financial assistance. 9-12 Resources for children in need of assistance. 12-17 Information on the Affordable Care Act, and Insurance terminology.

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Domestic Violence, Free Clinics

National Domestic Violence Hotline

1-800-799-SAFE (7233)

For nearly 20 years, the National Domestic Violence Hotline has been the vital link to safety for women, men, children and families affected by domestic

violence. With the help of our dedicated advocates and staff, we respond to calls 24/7, 365 days a year.

DIAL: 2-1-1 Provides information for help with food, housing, employment, health care,

counseling and more.

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A complete list of free clinics in Maine can be found at

www.freeclinics.com

From the home page just choose Maine, or whichever state your searching from to find a complete list! The website also lists requirements, and any

other info needed.

Homelessness

144 State st, Portland, ME - 04101

(207)879-3000

The Root Cellar Medical and Dental Clinic Cumberland Ave, Portland, ME - 04101

207-756-8134

Portland street Public Health Center 20 Portland st, Portland, ME - 04101

207-874-8445

Homeless Teen Center - Portland 343 Cumberland Ave, Portland, ME -04101

207-756-8134

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Social Security Disability Insurance • On the Social Security Administration’s website

https://www.ssa.gov/disability/, they state, “Social Security Disability Insurance pays benefits to you and certain members of

your family if you are "insured," meaning that you worked long enough and paid Social Security taxes.”

Supplemental Security Income

• Also in the website the Social Security Administration states, “Supplemental Security Income pays benefits based on financial

need.”

First Baptist Church Portland Food Pantry, 207-773-3123

Wed 11:30a-12:30p, 360 Canco Rd, Portland, ME 04103, 207-773-3123

Qualifications: Complete application at church on first visit.

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Community Policing Center (Portland Housing Authority)

207-773-4753

Activities for children, contact with city health officials, tickets for cultural events, tenant/landlord conflict resolution, contact with Portland Police in non-

emergency situations. For residents of Portland living in Portland Housing Authority developments.

Hours of Operation: Mon-Fri 9a-5p

14 Baxter Boulevard, Portland, ME 04103

New England Family Institute 207-871-1000

Clinical services for those requiring mental health, marital, and family

counseling.

125 Presumpscot Street, portland, me 04103

207-626-4600

Maine Housing is an independent state agency that bridges public and private housing finance, combining them to benefit Maine’s low and moderate-income

people. MaineHousing brings millions of new private and federal housing funds to invest in Maine to create safe, affordable, warm housing.

The mission of MaineHousing is to assist Maine people in obtaining and maintaining quality affordable housing and services suitable to their housing

needs.

353 Water Street, Augusta, ME 04330

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Mothers & Expectant Mothers

Houston Chronicle

Free Grants & Loans for Pregnant Women

http://smallbusiness.chron.com/grants-loans-pregnant-women-16705.html

Description: By clicking on this link it shows access to multiple different sub-websites which house many financially helpful options for pregnant women. Brief descriptions are provided as well as contact information for

the loans. Includes many different grants offered to pregnant women, such as

helping to get education, housing, insurance, and other personal expenses.

Healthcare.gov

1-800-318-2596 https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-get-pregnant/

Navigation: When on the home page, scroll over the “Get Answers” tab and find the link reading “pregnant women”. This will open a page solely

dedicated to help those who are pregnant and even those planning to conceive.

Description: Provides several different opportunities for financial help with regards to pregnant women and women attempting to get pregnant.

These opportunities range from private health coverage to Medicaid.

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Substance Abuse

The Office of Substance Abuse and Mental Health Services

1-800-499-0027(in Maine only) or 207-287-8900 Maine statewide information line: Monday - Friday, 8:00 - 5:00

The Resource Center can provide information about substance abuse and listings

of treatment agencies and support group meetings in Maine. http://www.maine.gov

à Agencies à Office of Substance Abuse

(207) 621-8118

Maine Ascociation of Substance Abuse Programs The Maine Association of Substance Abuse Programs, Inc. (MASAP) is a non-

profit membership organization recognized state-wide and nationally as the voice of substance use disorders and addiction in Maine. MASAP represents and

advocates for the continuum of substance use and addiction services throughout Maine, from prevention through treatment to recovery.

http://www.masap.org

207-775-4790

Milestone Foundation provides drug and alcohol addiction treatment to adult men and women experiencing chronic substance use issues. We offer a

continuum of services, including homeless outreach and overnight shelter, medically managed detox, residential treatment, transitional housing and

aftercare programs. http://milestonefoundation.org

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Nutrition & Financial Assistance

Maine Department of Health and Human Services

Office of Child Care Family Services 207-624-7900

This department maintains information on the rapidly changing resources

for Maine families/children. Application requirements vary.

2 Anthony Ave. Augusta, ME 04330

For financial assistance go to: http://www.maine.gov/dhhs/

—> Click on “Maine” —> Click Maine “Department of Health & Human Services”

—>Scroll down to “Food, money, housing” —>Click on “Public Assistance Application”

—>Click on “ Food Supplement, TANF, PaS, or MaineCare

Maine Temporary Assistance for Needy Families 207-287-3707

TANF, cash assistance, ASPIRE (Additional Support for People in Retraining and Employment), TANF work program.

221 State Street, State House Station #11, Augusta, ME 04333 http://www.maine.gov/dhhs/ofi/

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Assistance For Children

240-632-5300

To apply call: 800-675-8416 Mon-Fri 9am-5pm

Our mission is to assist children 18 years old or younger living with a chronic or

life-altering condition that their families are struggling to treat due to cost. Through this fund, we provide financial assistance to eligible families so their

children can start or continue critical medical treatments. Must be treated for a covered disease:

• Changes often, call application number to inquire. Health insurance:

• must have some form of health insurance • insurance must cover part of treatment cost.

Income guidlines: • will assist families up to 500% over the federal poverty level.

• In 2015 the poverty level for 3-person family is $20,090 per year. • 5 times poverty line is over $100,000.

Grant applications are reviewed by committee on a bi-monthly basis. healthwellfoundation.org

--->General information --->Pediatric Assistance Fund

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310-276-7111

When compassion can’t wait and single parent families are in despair, we help with urgent expenses to allow these caregivers to stay at their child’s bedside

during catastrophic illness. Requirements:

• Only for single-parent families. • They respond within 24hours.

• Average award: $354. • Long electronic application

o Social worker MUST HELP you fill out form o Requires specific bill to be payed with account numbers included

http://andreriveroflife.org/ --->Social worker form

--->Fill out with a social worker from hospital

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The Transportation Assistance Fund:

314-241-1600 Alleviates the financial burden of travel, meals and lodging for families

who have a child with cancer. Eligibility:

• Child must be diagnosed with cancer. If child has a brain tumor, the tumor must be high grade (III or IV) or anaplastic to be

eligible. • Child must have been diagnosed on or before his/her 18th

birthday and treated before his/her 21st birthday. Adults who relapse after their 18th birthday and who were not previously

assisted are not eligible for services. • Child must be a citizen of the United States or reside in the

United States with an I-551 card (green card) for 12 months without prior history of the current illness.

• Guardian applying for assistance must have less than $5,000 in easily accessible bank accounts (such as checking and savings).

The Emergency Assistance Fund: Provides $300 in emergency assistance per year to families who have a child that has been inpatient or away from home for (30) consecutive

days within the past three months. (continued on next page)

• Transportation Assistance Fund eligibility must be met • Child must have been inpatient for 30 consecutive days during

the past 90 days OR child must have been away from home/relocated for treatment for 30 consecutive days during the

past 90 days. Apply to either fund:

Contact: 800-5-FAMILY (families only) 314-241-1600 thenccs.org

--->How we Help --->Financial Assistance

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Never Ever Give Up!

Sends care packages to kids with cancer to help them Never Ever Give Up!

Apply online: negu.org

--->Click “3 horizontal line” button on upper left side of screen --->Get Support

--->Kids --->Year of Joy (complete application)

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Information on Insurance

650-887-0788

Written By: Ben Wanamaker and Devin Bean Description: Provides in-depth information on what the Affordable Care Act is as well as how it is used. Specifically bolds important terms in order to clarify necessary information to make comprehending the information

simpler. http://www.christenseninstitute.org/publications/aca/?gclid=CjwKEAiA3aW2BRCD_cOo5oCFuUMSJADiIMILLvHi00UKMKnId_3eHG1L3yfkKHv

WNVjkenP0PjpPbhoCovXw_wcB

United States Department of Labor

1-866-444-EBSA (3272)

Navigation: Under the “Health Reform” tab there is a link to the

“Consumer Information on the Affordable Care Act”. This will lead you directly to a page describing the ACA as well as separating two options for

consumers. Imbedded in this article are videos and links for better understanding.

http://www.dol.gov/ebsa/healthreform/consumer.html

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Insurance Glossary Allowed Amount: Maximum amount on which payment is based

for covered health care services. This may be called “eligible expense,” “payment allowance" or "negotiated rate." If your provider charges more than the allowed amount, you may have to pay the difference. (See Balance Billing.)

Appeal: A request for your health insurer or plan to review a decision or a grievance again.

Balance Billing: When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services.

Co-insurance: Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay co-insurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.

Complications of Pregnancy: Conditions due to pregnancy, labor and delivery that require medical care to prevent serious harm to the health of the mother or the fetus. Morning sickness and a nonemergency caesarean section aren’t complications of pregnancy.

Co-payment: A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.

Deductible: The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1000, your plan won’t pay anything until you’ve met your $1000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.

Durable Medical Equipment (DME): Equipment and supplies ordered by a health care provider for everyday or extended use. Coverage for DME may include: oxygen equipment, wheelchairs, crutches or blood testing strips for diabetics.

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Emergency Medical Condition: An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm.

Emergency Medical Transportation: Ambulance services for an emergency medical condition.

Emergency Room Care: Emergency services you get in an emergency room.

Emergency Services: Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.

Excluded Services: Health care services that your health insurance or plan doesn’t pay for or cover.

Grievance: A complaint that you communicate to your health insurer or plan.

Habilitation Services: Health care services that help a person keep, learn or improve skills and functioning for daily living. Examples include therapy for a child who isn’t walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings.

Health Insurance: A contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium.

Home Health Care: Health care services a person receives at home. Hospice Services: Services to provide comfort and support for

persons in the last stages of a terminal illness and their families. Hospitalization: Care in a hospital that requires admission as an

inpatient and usually requires an overnight stay. An overnight stay for observation could be outpatient care.

Hospital Outpatient Care: Care in a hospital that usually doesn’t require an overnight stay.

In-network Co-insurance: The percent (for example, 20%) you pay of the allowed amount for covered health care services to providers who contract with your health insurance or plan. In-network co-insurance usually costs you less than out-of-network co-insurance.

In-network Co-payment: A fixed amount (for example, $15) you pay for covered health care services to providers who contract with your health insurance or plan. In-network co-payments usually are less than out-of-network co-payments.

Medically Necessary: Health care services or supplies needed to prevent, diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.

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Network: The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.

Non-Preferred Provider: A provider who doesn’t have a contract with your health insurer or plan to provide services to you. You’ll pay more to see a non-preferred provider. Check your policy to see if you can go to all providers who have contracted with your health insurance or plan, or if your health insurance or plan has a “tiered” network and you must pay extra to see some providers.

Out-of-network Co-insurance: The percent (for example, 40%) you pay of the allowed amount for covered health care services to providers who do not contract with your health insurance or plan. Out-of-network co-insurance usually costs you more than in-network co-insurance.

Out-of-network Co-payment: A fixed amount (for example, $30) you pay for covered health care services from providers who do not contract with your health insurance or plan. Out-of-network copayments usually are more than in-network co-payments.

Out-of-Pocket Limit: The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges or health care your health insurance or plan doesn’t cover. Some health insurance or plans don’t count all of your co-payments, deductibles, co-insurance payments, out-of-network payments or other expenses toward this limit.

Physician Services: Health care services a licensed medical physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) provides or coordinates. (See page 4 for a detailed example.) Jane pays 0% Her plan pays 100% Glossary of Health Coverage and Medical Terms Page 3 of 4

Plan: A benefit your employer, union or other group sponsor provides to you to pay for your health care services.

Preauthorization: A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost.

Preferred Provider: A provider who has a contract with your health insurer or plan to provide services to you at a discount. Check your policy to see if you can see all preferred providers or if your health insurance or plan has a “tiered” network and you must pay extra to see some providers.

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Your health insurance or plan may have preferred providers who are also “participating” providers. Participating providers also contract with your health insurer or plan, but the discount may not be as great, and you may have to pay more.

Premium: The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.

Prescription Drug Coverage: Health insurance or plan that helps pay for prescription drugs and medications. Prescription Drugs Drugs and medications that by law require a prescription.

Primary Care Physician: A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services for a patient.

Primary Care Provider: A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of health care services.

Provider: A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), health care professional or health care facility licensed, certified or accredited as required by state law.

Reconstructive Surgery: Surgery and follow-up treatment needed to correct or improve a part of the body because of birth defects, accidents, injuries or medical conditions.

Rehabilitation Services: Health care services that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled. These services may include physical and occupational therapy, speech-language pathology and psychiatric rehabilitation services in a variety of inpatient and/or outpatient settings.

Skilled Nursing Care: Services from licensed nurses in your own home or in a nursing home. Skilled care services are from technicians and therapists in your own home or in a nursing home.

Specialist: A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.

UCR (Usual, Customary and Reasonable): The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount.

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Urgent Care: Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.

Source: Glossary of Health Coverage and Medical Terms from The Center

for Consumer Information & Insurance Oversight at cms.gov/CCIIO Other useful glossaries: http://www.ehealthinsurance.com/health-insurance-glossary/terms-a/

healthcare.gov ---> (scroll to bottom) Glossary