Written by a parent, not a doctor. Nothing here is medical advice.

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Maryland program

How fast the plan must answer a prior authorization

Time limits for Maryland-regulated plans to answer treatment requests. An urgent need has a faster clock.

What it is

Time limits for Maryland-regulated plans to answer treatment requests. An urgent need has a faster clock.

Waiting for the plan's answer can disrupt treatment. Maryland sets deadlines once the review agent has the information needed to decide. Knowing what is missing and when the last item arrived helps the clinic check that clock.

Eligibility rules
  • The rule applies to Maryland-regulated insurers, nonprofit health service plans, HMOs and defined review agents. Self-funded employer plans are outside this state rule.
What you get
  • An answer within two working days for an ordinary complete request.
  • One working day for more visits or days in an existing treatment course.
  • A 24-hour emergency decision and a deemed-approval rule when applicable deadlines are missed.
What the help covers
  • Qualifying electronic drug requests can receive real-time approval. The insurer remains responsible when pharmacy benefits are delegated.
  • Step-therapy exceptions include a contraindicated drug, an expected ineffective drug or a child already stable on the prescribed drug. A relevant earlier prescription has a 180-day lookback.
If you decide to apply
  1. Ask the clinic and plan to identify any missing information and when the complete request arrived.
  2. Have the request number and dates of calls, uploads or faxes ready.
  3. If the clock has passed, ask the plan to review the request under Maryland's deemed-approval rule.

Your health plan · Maryland Insurance Administration, 1-800-492-6116 · Official page ↗

After you apply
  • Keep a note of what was sent and when; the clock starts when the plan has everything.
Good to know

The clock starts with the information needed for a decision, not necessarily the first request. Exceptions can affect deemed approval.

Other details
  • The statutory missed-deadline approval rule has exceptions. A late answer is a reason to check the rule, not a guarantee that every requested service is covered.
Official sources
Ask your social worker

“Has the plan received everything it needs, and which deadline applies to our child's request? Could you help check urgent review or deemed approval and explain the options if it still says no?”

Why I’m asking: I want treatment decisions made within the time the rules allow.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Track what is outstanding and the date the plan had everything.

Your social worker

The oncology team sends the clinical information and can push for the urgent clock.

The care team

Records and letters when the application asks for them.

Who decides
The plan or its review agent; the Maryland Insurance Administration enforces the deadlines.
Ask your social worker
“What is the plan still waiting on for this authorisation, and what date did it receive the last piece? Maryland gives two working days, or 24 hours if it is urgent.”

How to apply

First step: Ask the plan what is outstanding and what date it received the last piece.

  1. Ask the plan what is still missing and get the team to send it the same day.
  2. Write down the date and time the plan had everything.
  3. If the deadline passes, say the words deemed approved and put it in writing.

Official application / program page ↗

Where it starts: Ask the plan in writing what information is outstanding, and when it received the last piece.

What to gather

  • The authorisation reference number
  • Dates and times of every call and fax

How long: Two working days ordinarily, one for more visits in a running course, 24 hours in an emergency.

What a yes looks like

An authorisation number and the dates it covers.

What a no looks like, and the next move

If the deadline passed, put deemed approval in writing. Otherwise take the refusal to the state insurance regulator.

Watch out

  • The clock starts when the plan has everything it needs, not when the request went in.
  • Self-funded employer plans sit outside these deadlines.
  • If your child is already stable on a drug, say so: that is a listed step-therapy exception.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Two working days for an ordinary request, one working day for more visits in a course already running, 24 hours in an emergency, and real-time approval for qualifying electronic drug requests. Missing the deadline means the request is deemed approved.

  • $2 — Working days for an initial non-emergency determination
  • $1 — Working day for more visits or days within an existing course of treatment
  • $24 — Hours for an emergency determination
  • $180 — Days within which a prescriber's earlier order protects a drug from step therapy

Legal protection: A request is deemed approved if the plan misses the statutory deadline, subject to the statute's exceptions · Step therapy exceptions where the required drug is contraindicated, is expected to be ineffective, or where the child is already stable on the prescribed drug · The duty stays with the insurer even where the drug benefit is delegated to a pharmacy benefit manager

What it costs the family: None.

The eligibility facts, as published

Plan type
Maryland-regulated insurers, nonprofit health service plans and health maintenance organizations, and the defined private review agents acting for them. Self-funded employer plans sit outside.
Clock start
When the review agent receives the information necessary to make the determination

The trap: The clock starts when the plan has all the information it needs, not when the request is sent. Ask what is still missing and get it sent the same day.

Where I read this

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