, but this code // executes before the first paint, when

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is not yet present. The // classes are added to so styling immediately reflects the current // toolbar state. The classes are removed after the toolbar completes // initialization. const classesToAdd = ['toolbar-loading', 'toolbar-anti-flicker']; if (toolbarState) { const { orientation, hasActiveTab, isFixed, activeTray, activeTabId, isOriented, userButtonMinWidth } = toolbarState; classesToAdd.push( orientation ? `toolbar-` + orientation + `` : 'toolbar-horizontal', ); if (hasActiveTab !== false) { classesToAdd.push('toolbar-tray-open'); } if (isFixed) { classesToAdd.push('toolbar-fixed'); } if (isOriented) { classesToAdd.push('toolbar-oriented'); } if (activeTray) { // These styles are added so the active tab/tray styles are present // immediately instead of "flickering" on as the toolbar initializes. In // instances where a tray is lazy loaded, these styles facilitate the // lazy loaded tray appearing gracefully and without reflow. const styleContent = ` .toolbar-loading #` + activeTabId + ` { background-image: linear-gradient(rgba(255, 255, 255, 0.25) 20%, transparent 200%); } .toolbar-loading #` + activeTabId + `-tray { display: block; box-shadow: -1px 0 5px 2px rgb(0 0 0 / 33%); border-right: 1px solid #aaa; background-color: #f5f5f5; z-index: 0; } .toolbar-loading.toolbar-vertical.toolbar-tray-open #` + activeTabId + `-tray { width: 15rem; height: 100vh; } .toolbar-loading.toolbar-horizontal :not(#` + activeTray + `) > .toolbar-lining {opacity: 0}`; const style = document.createElement('style'); style.textContent = styleContent; style.setAttribute('data-toolbar-anti-flicker-loading', true); document.querySelector('head').appendChild(style); if (userButtonMinWidth) { const userButtonStyle = document.createElement('style'); userButtonStyle.textContent = `#toolbar-item-user {min-width: ` + userButtonMinWidth +`px;}` document.querySelector('head').appendChild(userButtonStyle); } } } document.querySelector('html').classList.add(...classesToAdd); })();

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Office of the fb88 State Treasurer

Home → Independent Dispute Resolution - Uninsured Form

Independent Dispute Resolution - Uninsured Form

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Your Information

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Last *

Telephone Primary *

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Address *

City/Town *

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ZIP/Postal Code *

Medical Service Provider Information

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First *

Middle

Last *

Address *

City/Town *

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ZIP/Postal Code *

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Service Information

Date of Service

Type of Service Provided *

Was the total bill for this service greater than $750?

Yes

No

Please provide a copy of the bill to Insurance.PFR@maine.gov or send a fax to (207)-624-8599.

The dollar figure you will accept as the amount for the dispute:

Any other information you believe relevant:

Attestation:

I hereby agree to be bound by the outcome of the IDR, to submit to the jurisdiction of the Superintendent, and the courts of this State in this matter. I also affirm that the information provided in this application is true and accurate to the best of my knowledge.

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Date *