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

In Maryland, your health plan is regulated by Maryland Insurance Administration (MIA), if it is a state-regulated plan.

Maryland runs its own independent review of denials: Appeals and Grievance complaint to the Maryland Insurance Administration (review by an independent review organization). 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.

Maryland Medicaid

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

Marketplace (Maryland Health Connection) 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 Maryland?

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 – Maryland Health Connection
90 days

All the details →

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 get it from an employer that does business only in Maryland, the Maryland Insurance Administration can help. If your job-based plan is self-insured (often a large employer or one with locations in several states), contact the U.S. Department of Labor's Employee Benefits Security Administration.

Step 1: Appeal to your plan in Maryland

What it is called: Grievance (for medical necessity denials, called adverse decisions) or internal appeal (for other coverage decisions)

For a medical necessity denial, your insurer or HMO must decide your grievance in writing within 30 working days (45 working days if the care was already given). It can take up to 30 more working days only if you or your provider agree in writing. In an emergency case, it must decide within 24 hours. For other coverage decisions (not about medical necessity), the insurer must decide your internal appeal within 60 working days. Your doctor or another representative can file for you. The denial letter must give the detailed reasons, the exact criteria used, and the contact details of the Attorney General's Health Education and Advocacy Unit, which can help you file. Federal rules can require a faster decision (for example 72 hours for urgent care); where they do, the shorter time applies.

Law: Md. Code, Insurance 15-10A-02(b), (f), (h); Md. Code, Insurance 15-10D-02(b)

All the details →

Step 2: Outside review in Maryland

Appeals and Grievance complaint to the Maryland Insurance Administration (review by an independent review organization)

Deadline to ask: 4 months.

All the details →

Urgent care in Maryland: faster decisions

Appeal to your plan

  • Your plan must decide an urgent appeal within 24 hours.

Outside review

In an emergency case, the Commissioner must make a final decision within 24 hours after the complaint is filed. An emergency case is care not yet given that, without immediate attention, would seriously jeopardize your life, health or ability to regain maximum function, put you in danger to yourself or others, or lead to continued dangerous substance use.

Law: Md. Code, Insurance 15-10A-02(b)-(d), 15-10A-03, 15-10D-02

Urgent: 24 hours

Medicaid

If the Department finds that waiting for a standard hearing could seriously jeopardize your life, health or ability to attain, maintain or regain maximum function, the appeal is marked for expedited resolution and must be heard and decided within 3 working days after the Office of Administrative Hearings receives the request.

Law: COMAR 10.01.04.04

Complaints about your plan in Maryland

For other problems with an insurer or HMO, you can file a complaint with the MIA online, by mail, fax or email. The MIA says to allow 90 days for a decision on a general complaint. If you have a disability and need to file by phone, call 410-468-2244.

enterprise.insurance.maryland.gov

Medicaid (Maryland Medicaid (Medical Assistance), including HealthChoice managed care; Maryland Children's Health Program (MCHP)) denials in Maryland

Who holds the hearing: Maryland Office of Administrative Hearings (OAH).

Hearing deadline: 90 days

All the details →

Marketplace decisions in Maryland

Marketplace

Maryland Health Connection · 1-855-642-8572

Appeal deadline

90 days

The date of the eligibility decision

How to appeal

First ask for a case review by phone (1-855-642-8572), by mail (Maryland Health Connection, P.O. Box 6167, Fredericksburg, VA 22403) or by email (MHBE.Appeals@maryland.gov) with the Request for Case Review or Fair Hearing form. Include your application ID. If you still disagree after the case review, you get a notice explaining how to ask for a hearing at the Office of Administrative Hearings, 11101 Gilroy Road, Hunt Valley, MD 21031.

Form

Request for Case Review or Fair Hearing (form 1908)

Coverage while you appeal

If you ask for a hearing within 90 days from the date of the decision, you can still enroll in a qualified health plan and get the tax credits you currently qualify for; you may have to repay tax credits depending on the result. The HEAU (410-528-1840 or 1-877-261-8807) can help you prepare but cannot represent you at the hearing.

Law: form 1908; COMAR 10.01.04.04

Other rights in Maryland

How fast a prior approval must be decided

A utilization review agent must decide a non-emergency prior approval within 2 working days after it gets the information it needs, an extended stay or added services within 1 working day, and an emergency request within 24 hours. If it misses these time limits, the request is treated as approved.

Law: Md. Code, Insurance 15-10B-06(a), (d), (e)

Mental health and substance use emergency admissions

If prior approval is required for an emergency inpatient admission or residential crisis services for a mental health or substance use disorder, the decision must be made within 2 hours after the needed information is received.

Law: Md. Code, Insurance 15-10B-06(b)

Talking to the doctor who denied care

If your provider asks for immediate reconsideration of a denial, the review agent must let your provider speak by phone with the physician who made the decision within 24 hours.

Law: Md. Code, Insurance 15-10B-06(f)

Artificial intelligence in prior approval and claim reviews

Since October 1, 2025, an insurer, HMO, pharmacy benefit manager or review agent that uses artificial intelligence, an algorithm or other software in utilization review must base the decision on your own medical history and your provider's information, and the software may not deny, delay or change health care services. A health care provider must still make the decision.

Law: Md. Code, Insurance 15-10B-05.1 (2025 Md. Laws ch. 747, HB 820)

How long do I have? Deadline calculator

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

Good to know in Maryland

  • In Maryland the insurer has the burden of proving its denial was correct when the Insurance Commissioner reviews your complaint.

    Law: Md. Code, Insurance 15-10A-03(e)

  • Maryland gives Medicaid managed care members 120 days after receiving the plan's notice to ask for a fair hearing, and 90 days for other Medicaid decisions.

    Law: COMAR 10.01.04.04D

  • Prior approval requests that are not decided on time are treated as approved.

    Law: Md. Code, Insurance 15-10B-06(e)

Changes in 2024–2026

2025 Md. Laws ch. 747, effective October 1, 2025, added Insurance 15-10B-05.1: artificial intelligence, algorithms and other software used in utilization review may not deny, delay or modify health care services and must not replace the role of a health care provider in the decision.

Law: HB 820

Questions about appeals in Maryland

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

Maryland law does not set a longer general deadline. For a denial of care you already received (a retrospective denial), you have at least 180 days after you receive the denial. 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 Maryland?

Appeals and Grievance complaint to the Maryland Insurance Administration (review by an independent review organization). File online through the MIA secure consumer portal, or mail or fax the Life and Health complaint form with the signed medical records release to: Maryland Insurance Administration, Attn: Consumer Complaint Investigation, Life and Health/Appeals and Grievance, 200 St. Paul Place, Suite 2700, Baltimore, MD 21202. Fax 410-468-2270 (Appeals and Grievance) or 410-468-2260 (Life and Health).

Is outside review free in Maryland?

The Maryland Insurance Administration does not charge a fee to file a complaint.

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

90 days. The date on your notice

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

To keep your Medicaid while your appeal is pending, appeal within 10 calendar days of the date on your notice, the postmark, or the effective date of the action, whichever is later. For example, if the notice is dated June 20, postmarked June 24 and your coverage ends June 30, appeal within 10 days of June 30.

How do I appeal a Marketplace decision in Maryland?

First ask for a case review by phone (1-855-642-8572), by mail (Maryland Health Connection, P.O. Box 6167, Fredericksburg, VA 22403) or by email (MHBE.Appeals@maryland.gov) with the Request for Case Review or Fair Hearing form. Include your application ID. If you still disagree after the case review, you get a notice explaining how to ask for a hearing at the Office of Administrative Hearings, 11101 Gilroy Road, Hunt Valley, MD 21031.

Not about a denied claim?

Nearby states

Sources

Sources