External review in Maryland: deadline, cost and how to ask
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.
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.
Step 2: Outside review in Maryland
- Program
Appeals and Grievance complaint to the Maryland Insurance Administration (review by an independent review organization)
- Who runs it
- Maryland Insurance Administration, Appeals and Grievance Unit: Insured health plans and HMOs regulated in Maryland
- Deadline to ask
4 months
You can file a complaint with the Insurance Commissioner within 4 months after you receive the grievance decision. The Commissioner must decide within 45 days (24 hours in an emergency case), and may take up to 30 more working days if information it asked for is missing.
- The deadline runs from
The date you receive the insurer's or HMO's grievance decision (or adverse decision)
- Do I have to appeal to my plan first?
Usually you must finish the insurer's or HMO's grievance process first. You can go straight to the MIA if the insurer waives this, if it did not follow the grievance rules, if you show a compelling reason (for example, a delay could cause serious harm), or if you get no grievance decision by the 30th working day. For a coverage decision about an urgent condition when care has not been given, you can file with the MIA without appealing first.
- When you can go without a plan answer
30 business days after you file your internal appeal
- How long the review takes
Urgent: 24 hours
- Cost
The Maryland Insurance Administration does not charge a fee to file a complaint.
- What can be reviewed
Denials of care as not medically necessary, including cosmetic, dental, experimental or investigational, prior authorization and prescription drug issues. For medical necessity questions the Commissioner gets advice from an independent review organization or medical expert. Other coverage decisions can also be reviewed by the MIA but may not go to an independent medical expert.
- Is the decision final?
If the treatment is found medically necessary, the Commissioner can overturn the denial and order the insurer or HMO to pay under your policy. The insurer has to prove its decision was correct, and either side can ask for a hearing on the Commissioner's decision.
- How to ask
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). You can also email agcomplaints.mia@maryland.gov. Attach the denial and grievance decision letters and any information you want considered.
Law: Md. Code, Insurance 15-10A-02(b)-(d), 15-10A-03, 15-10D-02
- Forms and online request
- Phone
410-468-2000 or 1-800-492-6116 (TTY 1-800-735-2258)
Write my appeal: free letters
Sources
The official sources for Maryland are listed on the Maryland page.