Health insurance or Medicaid said no in Delaware? Deadlines and free help

In Delaware, your health plan is regulated by Delaware Department of Insurance (Consumer Services Division), if it is a state-regulated plan.

Delaware runs its own independent review of denials: Independent Health Care Appeals Program (IHCAP). You generally have 4 months to ask for it.

External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.

Pick your plan type

Which kind of coverage was denied? The plan type decides which rules and deadlines apply.

Insurance I bought or got through work

Your state insurance rules may apply. First appeal to your plan, then ask for an outside review.

My employer pays claims itself (self-funded)

Federal rules apply, and most state insurance laws do not. Free help comes from the U.S. Department of Labor.

Delaware Medicaid

You ask the state for a fair hearing. In a Medicaid health plan, you usually appeal to the plan first.

Marketplace (HealthCare.gov) decision

A decision about whether you can buy a plan or get financial help is appealed to the Marketplace.

How long do I have?Urgent care: faster decisionWrite my appealFree help

Checked against official sources: October 30, 2026.

Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.

How long do I have in Delaware?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
4 months
Hearing deadline
90 days
Appeal to the plan first
60 days (federal rule)
Then a state hearing
120 days
Appeal deadline – HealthCare.gov
90 days (federal rule)

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How long do I have? Deadline calculator

How do I know which plan type I have?

How to tell which agency regulates your plan

If you bought insurance yourself or have insurance from an employer that does business only in Delaware, contact the Delaware Department of Insurance. If your plan is a self-insured employer plan (often a large company or one in several states), contact the U.S. Department of Labor. The Department cannot help when a policy was issued and delivered in another state.

Step 1: Appeal to your plan in Delaware

What it is called: Grievance (internal review process)

You can file a grievance orally or in writing; the carrier must give you a written form and acknowledge your written grievance within 5 business days. The carrier must decide within 72 hours for an emergency review, within 30 days for referrals or questions about whether a requested benefit is covered, and within 45 days in other cases, counted from when it has all needed information, and must mail its written decision within 5 days after deciding. The decision must give the reasons, the policy language relied on, the clinical rationale, and how to ask for external review, and must tell you about the Department of Insurance's free mediation services (mediation does not stop the deadlines).

Law: 18 Del. C. 332(c); 18 DE Admin. Code 1301-3.0, 4.0

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Step 2: Outside review in Delaware

Independent Health Care Appeals Program (IHCAP)

Deadline to ask: 4 months.

All the details →

Urgent care in Delaware: faster decisions

Outside review

You can ask for an expedited external review when the carrier issues its final decision if your condition poses an imminent, emergent or serious threat or you have an emergency medical condition. The carrier must send the request to the Department within 3 business days; the independent reviewer decides within 72 hours.

Law: 18 Del. C. 6416, 6417(b); 18 DE Admin. Code 1301-5.0 to 8.0; DOI, Procedure for IHCAP applications (04/2019)

Medicaid

An expedited fair hearing is available for Medicaid and the Delaware Healthy Children Program when the standard timeframe could seriously jeopardize your life or health or your ability to attain, maintain or regain maximum function, for a decision to end, reduce or suspend services or to deny or limit a new service. The decision is due within 3 working days after the request is received.

Law: DSSM 5000 (Fair Hearing Practice and Procedures), secs. 5304.3, 5305, 5308, 5500; DMMA Administrative Notice A-13-2025 (Nov. 13, 2025); 42 CFR 431.221(d)

Complaints about your plan in Delaware

The Department of Insurance's Consumer Services Division can forward your complaint to the insurer, get explanations, check compliance and help with appeals about medical claims. File online with the complaint form, email consumer@delaware.gov, or call 1-800-282-8611 in Delaware or (302) 674-7310. For a denial that is not about medical necessity, you can ask the Insurance Commissioner for arbitration in writing within 60 days of the carrier's final written decision; the fee to you is at most $75 and a decision is due within 45 days.

Law: 18 Del. C. 332(e)-(f)

insurance.delaware.gov

Medicaid (Delaware Medicaid (Diamond State Health Plan) and Delaware Healthy Children Program) denials in Delaware

Who holds the hearing: DSS Fair Hearing Office (DSS hearing officers).

Hearing deadline: 90 days

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Marketplace decisions in Delaware

Delaware uses HealthCare.gov. Appeals go to the federal Marketplace Appeals Center.

HealthCare.gov

1-855-231-1751

Other rights in Delaware

Arbitration for denials not about medical necessity

If your carrier's final decision is based on something other than medical necessity or appropriateness (for example, whether a benefit is covered), you can ask the Insurance Commissioner for arbitration. Mail a written request within 60 days of receiving the carrier's final written decision. You pay no more than $75; the carrier pays the rest. A decision is due within 45 days. If you win, the arbitrator's decision controls for you even if the carrier appeals to court.

Law: 18 Del. C. 332(e)-(g), 6416(f)

Department of Insurance mediation

Carriers must tell you about the Department of Insurance's mediation services in their final grievance decision. Mediation does not change the deadlines for external review or arbitration.

Law: 18 Del. C. 332(c)(7)

How long do I have? Deadline calculator

Pick your plan type and enter the dates on your notice. We count from the rules in Delaware and the federal rules.

Worked out in your browser. Nothing you enter here is saved or sent.

If you are not sure when it arrived, use the date printed on the notice. That date is never later than the day it arrived.

Choose what was decided and enter the date on your notice

We add the number of days or months from the law to your date. Nothing is saved.

Write my appeal: free letters

Free help in Delaware

Good to know in Delaware

  • In Delaware you file the external review request with your health carrier, which must send it to the Department of Insurance for assignment of an independent reviewer (18 Del. C. 6416(c)-(d)).
  • The 4 months for external review count from the date the carrier issued its final decision (18 Del. C. 6416(c)); the Department's procedure counts from the letter date, not when you received it.
  • Delaware offers state arbitration, with a fee capped at $75, for coverage denials that are not about medical necessity (18 Del. C. 332(e)-(f)).

Changes in 2024–2026

Delaware Medicaid resumed normal fair hearing decision timeframes on July 1, 2025, after its temporary CMS authority under section 1902(e)(14)(A) ended June 30, 2025. A revised 18 Del. C. 332 takes effect January 1, 2028 (85 Del. Laws c. 480), with only a definition change seen in the text. Delaware's Marketplace remains on HealthCare.gov for plan year 2027; open enrollment starts November 1, 2026 (Delaware DOI news release, Sept. 4, 2026). The Delaware Pre-Authorization Act of 2025 sets uniform pre-authorization standards for health insurance policies issued or renewed in Delaware after December 31, 2026 (Delaware DOI Universally Applicable Bulletin No. 11, Nov. 6, 2025).

Law: SB 12 with SA 1, effective August 25, 2025

Source: DMMA Administrative Notice A-13-2025

Questions about appeals in Delaware

How long do I have to appeal a health insurance denial in Delaware?

Delaware's statute says a grievance must be filed within 30 days of receiving the written denial. The Department of Insurance's IHCAP procedure describes filing the first appeal within 180 days, which matches the federal rule for most plans. You have at least 180 days (about 6 months) from when you receive the denial notice to file an internal appeal.

How do I get an outside (external) review in Delaware?

Independent Health Care Appeals Program (IHCAP). Send your written request for external review to your health carrier. The carrier must send a copy to the Department of Insurance, which assigns an IURO. The IURO will write to you; you have 7 days after that notice to send more information.

Is outside review free in Delaware?

External review is free for you. The carrier pays all costs of the review, including the Department's $75 administration fee.

How long do I have to ask for a Medicaid fair hearing in Delaware?

90 days. The date on the notice of action (the date it was mailed)

Can I keep my Medicaid benefits while I appeal in Delaware?

Your Medicaid continues until the hearing decision if your hearing request is received during the timely notice period, the 10 days between the date the notice is mailed and the date the change takes effect. If the hearing officer upholds the action, the agency may recover the cost of benefits you got while waiting.

Who regulates health insurance in Delaware?

Delaware Department of Insurance (Consumer Services Division). If you bought insurance yourself or have insurance from an employer that does business only in Delaware, contact the Delaware Department of Insurance. If your plan is a self-insured employer plan (often a large company or one in several states), contact the U.S. Department of Labor. The Department cannot help when a policy was issued and delivered in another state.

Not about a denied claim?

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