Member Grievances and Appeals

Martin's Point plan members or their authorized representatives have the right to express complaints, frustrations, and disagreement about their experience interacting with health care providers, the plan and/or its administrators.

Under state and federal law, members can express those complaints through the Martin's Point grievance and appeals process.

Providers may also file a grievance or appeal on behalf of a current or former member by obtaining authorization from the member.

Grievance or Appeal?

A grievance is a member complaint about the way the health plan or drug plan is giving care.

For example, a member may file a grievance if they have a problem calling the plan or if they’re unhappy with the way a staff person at the plan behaved towards them.

However, if they have a complaint about a plan’s refusal to cover a service, supply, or prescriptions, they file an appeal.

How to Submit a Grievance

Members or their authorized representatives may submit a grievance by phone or mail:

How to Submit an Appeal

Appeals can be submitted by mail at the address below:

Martin's Point Health Care
P.O. Box 8832
Portland, ME 04104-9861