External Review – MARYLAND

Who should I call if I have any questions about filing a complaint?

You can contact the Maryland Attorney General’s Office at (410) 528-1840 or (877) 261-8807. The Office is open from 9:00 a.m. to 4:30 p.m. Monday through Friday.

What happens after the Attorney General’s Office receives my complaint?

Once the Attorney General’s Office receives your complaint, the representative will review the complaint and ensure that it is the best agency to handle it.[23] If the Attorney General’s Office determines that your complaint would be better handled by another agency,...

How do I file a complaint with the Maryland Attorney General’s Office?

You can also file a complaint with the Maryland Attorney General’s Office, either at the same time you file a complaint with the Maryland Insurance Administration or in lieu of filing a complaint with the Administration. Complaint information. You can find...

Who should I call if I have questions about filing a complaint?

If you file a complaint with the Administration, you can reach the agency at (410) 468-2000 or (800) 492-6116. The Administration is open from 8:00 a.m. to 5:00 p.m., Monday through Friday. You can also reach the agency after hours...

What happens after the Administration receives my complaint?

After the Administration receives your complaint, a representative will investigate. The process can take a few months to complete.[18] At the end of the representative’s investigation, the Commissioner of Insurance may require the health insurer to stop inappropriate conduct, fulfill its...

What if I think my insurer did something illegal?

The Administration protects consumers from illegal insurance practices.[14] If you are a Maryland resident and you believe your insurer did something illegal, you can file a complaint with the Administration. Information. You can find a copy of the complaint form here. Your complaint...

Do I have another option if I do not qualify for an external review?

If your insurer denied your claim because your plan does not cover the treatment or service, and you do not qualify for an external review, you still have another option. You can contact the Employee Benefits Division (“Division”) to request...

How long will the external review process take?

The external review process should take no more than 60 days. If you requested an expedited external review, the process should take no longer than four business days after your request is received.[11]

How do I request an external review?

You should submit your request for external review to the Maryland Insurance Administration (“Administration”) within 120 days from the date that the claim was denied.[8] How to submit a standard external review request. You should mail a written request to the...

In what circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[7] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. You are entitled to an external review in the following...

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