What is the average health insurance denial rate in Maryland?

Health insurers in Maryland deny approximately 15.6% of ACA marketplace claims, which is 3.5 points below the national average of 19.1%.

How do I appeal a denied insurance claim in Maryland?

File a written internal appeal with your insurer within 180 days of the denial. If denied again, escalate to an Independent Medical Review (IMR) with the Maryland Insurance Administration. IMRs are free, decided by independent clinicians, and have high success rates.

Which insurance company denies the most claims in Maryland?

Based on CMS Marketplace Transparency data, the insurers with the highest denial rates in Maryland are Kaiser Permanente, Aetna (CVS Health). See each insurer's full denial report for category-level breakdowns.

What are my rights if my insurance claim is denied in Maryland?

You have the right to a full written explanation of the denial, an internal appeal, and an external Independent Medical Review with the Maryland Insurance Administration. Federal law requires insurers to respond to standard appeals within 30 days and urgent appeals within 72 hours.

Maryland Insurance Denial Report

The worst health insurers in Maryland
by claim denial rate

Maryland averages a 15.6% denial rate — 3.5 points below the national average. About 230,000 claims are denied annually.

Fight My Denial in Maryland →

15.6%

Maryland avg denial rate

19.1%

National average

230,000

Annual denials in state

>80%

Appeals overturned when filed

Health insurance denials in Maryland

In Maryland, the average health insurance claim denial rate stands at 15.6%, which is notably lower than the national average of 19.1%. This means that while a significant number of claims are denied, Maryland residents experience a slightly better outcome compared to the national landscape. With approximately 230,000 denials occurring annually, it’s clear that many individuals face challenges when seeking the coverage they deserve. Understanding this denial rate is crucial for patients as it highlights the importance of being informed and proactive in navigating the healthcare system.

Patients in Maryland have the right to appeal denied claims, empowering them to challenge decisions made by their insurance providers. If an internal appeal does not yield a satisfactory outcome, individuals can escalate their concerns to the Maryland Insurance Administration, the state’s regulatory body overseeing insurance practices. This agency provides a framework for patients to ensure their voices are heard and their rights protected, enabling them to advocate for the care they need and deserve.

Worst insurers in Maryland by denial rate

Source: CMS Marketplace Transparency Report 2023. In-network ACA marketplace claims only.

Kaiser Permanente

12.4% denial rate

Kaiser denies 12.4% of claims — 6.7 points below the national average. Their appeal overturn rate is 70%.

GLP-1 Medications: 19% deniedSpecialty Medications: 15% deniedMental Health: 12% denied

Full Kaiser denial report →

Aetna (CVS Health)

17.2% denial rate

Aetna denies 17.2% of claims — 1.9 points below the national average. Their appeal overturn rate is 65%.

GLP-1 Medications: 28% deniedSpecialty Medications: 22% deniedMental Health: 18% denied

Full Aetna denial report →

Your rights as a Maryland insurance patient

In Maryland, patients benefit from specific protections regarding health insurance claim denials. They have the right to an internal appeal, allowing them to request a review of the denial by their insurer. If the outcome remains unfavorable, patients can seek an external Independent Medical Review, where an impartial third party evaluates the case. The Maryland Insurance Administration oversees these processes, ensuring compliance and fairness. Filing a complaint with this regulatory body is free and can serve as a powerful tool to encourage insurers to reconsider their decisions.

Maryland Insurance Administration
https://insurance.maryland.gov

Start My Maryland Appeal →

How to appeal a denial in Maryland

1
Request the denial in writing
Ask your insurer for the specific clinical criteria and coverage policy they used to deny you. They are legally required to provide it within 30 days.
2
File your internal appeal
Send a written appeal to your insurer within 180 days. Cite your doctor's clinical documentation, relevant medical guidelines, and Maryland insurance law. A well-written appeal citing specific laws wins over 80% of the time.
3
Escalate to the state if denied again
If your internal appeal is denied, file an Independent Medical Review (IMR) with the Maryland Insurance Administration. This is free and decided by independent clinicians. Their decision is often binding.
4
Use disputes.health to generate your letter
Our agents generate a clinic-grade appeal letter in under 15 minutes — citing your state's laws, relevant medical guidelines, and your specific situation. We then submit it to your insurer for you.

How to appeal a denial →GLP-1 denial guide →Mental health denial guide →All public resources →

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The worst health insurers in Marylandby claim denial rate