Starting January 1, 2026, you have the right to reasonable access to mental health or substance use disorder service providers, if you are covered by a fully insured health plan through an insurance company or HMO. For mental health or substance use disorders, if there are no appointments with an in-network provider available with a reasonable time or distance (as defined by Maryland regulation), your health plan is required to help you by arranging in-network coverage so you can see an out-of-network provider at no added cost to you.
Standards for reasonable wait times and distance to care are based on the level of care you need, the type of provider you need to see, and where you live. The specific standards for mental health and substance use disorder services are listed below.
If you are unable to get an appointment with a provider who is in-network under the standards outlined below, you have the option of requesting a referral from your health plan to an out-of- network provider that is available within the travel and wait-time standards. Your health plan is required to help you identify an available out-of-network provider and arrange for coverage for the provider as though the provider is in-network. Click here for information about the specific referral processes used by each health plan. The health plan must apply the same utilization review rules as they do for in-network providers and allow the out-of-network provider to care for you for the duration of any relevant treatment plan that you may have.
Once your health plan refers you to an out-of-network provider, your coverage will be the same as if you had seen an in-network provider, including any cost sharing amounts that you pay out of pocket, such as deductible, co-payment, or co-insurance. Your health plan is required by law to agree to a payment rate with your out-of-network provider that ensures you won’t owe any remaining balance to the provider after the provider is paid by your health plan.
Reasonable Wait Time. The wait time is measured from when you seek mental health or substance use disorder services to the earliest date an appointment is available with an innetwork provider. If you can’t get an appointment within the time frame below, ask your health plan for a referral to an available out-of-network provider with the skill and expertise to meet your behavioral health needs.
Reasonable Travel Distance. If your health plan is through an insurance company or most HMOs, travel distance is measured by the actual driving distance, based on turn-by-turn directions along public roads, from your home to the provider’s office or facility. If your health plan is through a group model HMO (e.g., Kaiser HMO), travel distance can also be measured by the driving distance from your workplace.
The standards for maximum distance (in miles) differ based on where you live: urban areas are zip codes with 3,000 or more people per square mile; suburban zip codes have 1,000 to 2,999 people per square mile; and rural zip codes have fewer than 1,000 people per square mile.
If your health plan is through an insurance company or most HMOs, you have the right to see a behavioral health provider within the distances below, based on the miles to drive from your home to the provider’s office or facility.
Addiction Medicine
| 10
| 25
| 60 |
Applied Behavioral Analyst
| 15
| 30 | 60 |
Licensed Clinical Social Worker
| 10
| 25 | 60 |
Licensed Professional Counselor
| 10
| 25
| 60
|
Psychiatry-Adolescent and Child, Outpatient
| 10
| 25
| 60 |
Psychiatry-Geriatric, Outpatient
| 10
| 25
| 60 |
Psychiatry-Outpatient
| 10
| 25
| 60 |
Psychology
| 10
| 25
| 60 |
All other licensed or certified mental health and substance use providers
| 15
| 40
| 90
|
Inpatient Psychiatric Facility
| 15
| 45
| 75 |
Opioid Treatment Services Provider
| 15 | 25
| 60 |
| Outpatient Mental Health Clinic | 15 | 30 | 60 |
| Outpatient Substance Use Disorder Facility | 15 | 30 | 60 |
| Pharmacy | 5 | 10 | 30 |
| Residential Crisis Services | 10
| 30
| 60 |
Substance Use Disorder Residential Treatment Facility
| 10 | 25 | 60 |
| All other licensed or certified mental health or substance use facilities | 15
| 40 | 90
|
If your health plan is through a group model HMO (e.g., Kaiser HMO), you have the right to see a behavioral health provider within the distances below, based on the miles to drive from your home or workplace to the provider’s office or facility.
Addiction Medicine
| 15 | 30
| 75 |
| Applied Behavioral Analyst | 15 | 20
| 60 |
| Licensed Clinical Social Worker | 15 | 30
| 75
|
| Licensed Professional Counselor | 15 | 30
| 75 |
| Psychiatry-Adolescent and Child, Outpatient | 15 | 30 | 60 |
Psychiatry-Geriatric, Outpatient
| 15 | 30 | 60 |
Psychiatry-Outpatient
| 15 | 30
| 60
|
Psychology
| 15 | 30 | 60
|
All other licensed or certified mental health and substance use providers
| 20 | 40 | 90
|
Inpatient Psychiatric Facility
| 15 | 45 | 75 |
| Opioid Treatment Services Provider | 15 | 30 | 60 |
| Outpatient Mental Health Clinic | 15
| 30
| 60
|
| Outpatient Substance Use Disorder Facility | 15
| 30
| 60
|
Pharmacy
| 5
| 10
| 30
|
Residential Crisis Services
| 15
| 30
| 60
|
Substance Use Disorder Residential Treatment Facility
| 15 | 30 | 60
|
All other licensed or certified mental health or substance use facilities
| 15 | 40 | 120 |
Get free help with your health coverage!
The Maryland Insurance Administration has a Health Coverage Assistance Team (H-CAT) to assist consumers. If you have questions or concerns about health coverage for you or your loved ones, the H-CAT staff is here for you.
- Get answers to your health insurance questions.
- Address health insurance problems or concerns.
- File a complaint about your health insurance issue or concern.
- Connect you to resources.
Phone: 410-468-2442
