State agency ยท Maryland Insurance Administration
Maryland Insurance Administration: appeals and grievances
Maryland's insurance regulator explains the state appeals and grievances law: you first use your plan's own grievance process, then you can ask the Insurance Administration to review a denial of medically necessary treatment.
Know before you go
The page says you may seek the Administration's help within 4 months after your plan's grievance (internal appeal) decision. If your case is an emergency, the plan must offer a decision within 24 hours, and in some cases you can skip the plan's process if there is a compelling reason. It covers health maintenance organization (HMO) and insurer plans regulated in Maryland; it does not cover self-funded employer plans, Medicare or Maryland Medicaid. The complaint must be in writing.
- Cost
- Not stated
- Where
- Maryland
- How to start
- Finish your plan's grievance process, then file a complaint with the Insurance Administration in writing, using the page's How to File instructions, within 4 months of the plan's decision. The Attorney General's Health Education and Advocacy Unit will help you file the appeal for free.
- Phone
- 410-468-2000 or 1-800-492-6116, as printed on the provider's page
- Have ready
- The plan's written grievance decision; Your denial letters; A signed medical records release; Your insurance card
Where this comes from
- Provider
- Maryland Insurance Administration
- Source we read
- https://insurance.maryland.gov/Consumer/Pages/AppealsAndGrievances.aspx
- Date we read it
- . This is not a fresh check.
- Date the provider printed
- Not displayed
- What we checked
- We read the provider's public page. We have not verified availability, eligibility or outcomes for any individual.
Other starting points
- Program or service
Beneficiary and Family Centered Care Quality Improvement Organizations: find yours
The Medicare contractors that handle fast appeals when hospital or other care is ending too soon, and complaints about the quality of care. Each state is assigned to one of two organizations.
From Centers for Medicare & Medicaid Services
- Program or service
California Department of Managed Health Care: Independent Medical Review
California's regulator for managed care plans reviews denials of medical services, emergency payment and experimental treatment through Independent Medical Review. One form starts either a review or a consumer complaint.
From California Department of Managed Health Care
- Program or service
Center for Medicare Advocacy self-help materials
Downloadable self-help toolkits for Medicare denials involving home health care, outpatient therapy and skilled nursing facility care, from a nonprofit law organization. The page describes materials, not a helpline.
From Center for Medicare Advocacy