Delaware: Start Here
Beginner guide for Delaware—Choose Health DE, IHCAP external review, 2025 PA reform, and what to open next.
Read guideState playbook
Delaware
State insurers, legislation, and appeal resources for patients and advocates in Delaware.
4 guides
Delaware Prior Authorization Law
5/3-day and 24/48-hour PA deadlines, deemed preauthorization, 90-day approvals, step-therapy exceptions.
Read guideDelaware Health Insurance Appeals and Grievances
IRP grievances—30-day filing, 72-hour to 45-day decisions, mediation option, path to IHCAP.
Read guideDelaware External Review (IHCAP)
Binding IURO review—4-month filing, 45-day standard, 72-hour expedited, fully insured DE plans.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- Highmark Blue Cross Blue Shield Delaware
- AmeriHealth Caritas Delaware
- Ambetter (Celtic)
- Delaware Medicaid (MCO)
External appeals
After internal appeal, for eligible Delaware fully insured plans only.
- Delaware DOI — IHCAP External Review
- Medicaid — State fair hearing