How to appeal a health insurance denial in Maryland
The short answer
Start with your plan’s own appeal. If the plan says no again, you can usually ask an independent reviewer to decide. Maryland lets you ask an independent reviewer to decide, through Maryland Insurance Administration. The deadline to ask: within 4 months after the date of receipt of the carrier's adverse decision or grievance decision (file a complaint with the Insurance Commissioner).
Does this apply to you? State external review covers plans regulated by Maryland: individual and Marketplace plans, and job-based plans your employer bought from an insurer. Many large employers are self-funded; their plans follow the federal external review process, and state law usually does not apply (29 CFR 2590.715-2719(c)(1)). Medicare, Medicaid, TRICARE and federal employee plans have their own appeals: see the plan guides.
External review in Maryland
Within 4 months after the date of receipt of the carrier's adverse decision or grievance decision (file a complaint with the Insurance Commissioner)
Emergency cases get a final MIA decision within 24 hours of the complaint being filed. For care not yet provided, you can skip the carrier's grievance and go straight to the MIA if you show a compelling reason (e.g., risk of loss of life or serious impairment). Standard complaints: 45 days, extendable by up to 30 working days.
Free (the carrier pays the independent review organization)
State-regulated plans (insurance bought in Maryland or through an employer that buys insurance). Self-funded employer plans use the federal process.
In Maryland external review is a complaint to the MIA Appeals and Grievance Unit (online portal, agcomplaints.mia@maryland.gov, or fax 410-468-2270); the MIA sends medical-necessity cases to an IRO and then issues the decision, and a signed medical-records release is required. The Attorney General's Health Education and Advocacy Unit (877-261-8807) helps for free with grievances and complaints. Covers Maryland fully insured plans and HMOs, not Medicaid, federal employee (FEHB) or self-funded plans.
Who to contact
- Maryland Insurance Administration
- External review information and forms
- Consumer help line: 800-492-6116
Before external review: the internal appeal
External review usually comes after your plan’s own appeal. The deadline for that first appeal depends on the type of plan:
- Employer plan: 180 days from the day you receive the denial notice
- Marketplace plan: 180 days from the day you receive the denial notice
- Medicare Advantage: 60 days from when you receive the denial (counted as 65 days from the notice date)
- Medicare Part D: 60 days from when you receive the denial (counted as 65 days from the notice date)
- Original Medicare: 120 days from when you receive the notice (counted as 125 days from the notice date)
- Medicaid: 60 days from the date printed on the denial notice
- FEHB (federal employees): 6 months from the date of the denial notice
- TRICARE: Mail within 90 days after the date of the denial notice
Questions people ask
How long do I have to ask for an external review in Maryland?
Within 4 months after the date of receipt of the carrier's adverse decision or grievance decision (file a complaint with the Insurance Commissioner)
Can I get a fast external review in Maryland?
Emergency cases get a final MIA decision within 24 hours of the complaint being filed. For care not yet provided, you can skip the carrier's grievance and go straight to the MIA if you show a compelling reason (e.g., risk of loss of life or serious impairment). Standard complaints: 45 days, extendable by up to 30 working days.
Does external review cost anything in Maryland?
Free (the carrier pays the independent review organization)
Do Maryland’s rules apply to my job-based plan?
Only if the plan is fully insured, meaning your employer bought a policy from an insurance company. Self-funded employer plans generally follow the federal external review process instead. Your Summary Plan Description or HR benefits team can tell you which kind you have.
Sources
- Md. Code, Insurance §15-10A-03
Within 4 months after the date of receipt of an adverse decision or a grievance decision
- MIA: File A Complaint (Life and Health / Appeals and Grievance)
If care has not been provided and you have a compelling reason to skip the internal grievance process, or it is an emergency case, your complaint will be expedited.
- Md. Code, Insurance §15-10A-05
The carrier that is the subject of the complaint shall be responsible for paying the reasonable expenses of the independent review organization
This page is general information about appeal rules in the United States. It is not legal or medical advice. Rules can change, and your plan’s documents and your denial letter control the dates that apply to you.