(a) This section applies to entities that propose to issue or deliver individual, group, or blanket health insurance policies or contracts in the State or to administer health benefit programs that provide for the coverage of health care services and the utilization review of those services, including: (1) an authorized insurer that provides health insurance in the […]
To provide a standard system of payment for medical services, each claim form for use under an individual or group health insurance policy that is issued or delivered in the State shall conform to a form or regulations that the Commissioner adopts.
(a) (1) In this section the following words have the meanings indicated. (2) (i) “Health care practitioner” means a person that is licensed or certified under the Health Occupations Article and reimbursed by a third party payor. (ii) “Health care practitioner” does not include a physician or other person licensed or certified under this article when the physician or other […]
(a) For services rendered by a person entitled to reimbursement under § 15–701(a) of this title or by a hospital, as defined in § 19–301 of the Health – General Article, an insurer, nonprofit health service plan, or health maintenance organization: (1) shall accept the uniform claims form and any attachments approved or adopted by the Commissioner […]
(a) In this section, “clean claim” means a claim for reimbursement, as defined in regulations adopted by the Commissioner under § 15–1003 of this subtitle. (b) To the extent consistent with the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq., this section applies to an insurer, nonprofit health service plan, or health […]
(a) On written request of the claimant, an insurer that denies a claim made on an individual health insurance policy shall give written notice to the claimant that states fully the reason for the denial. (b) The reason given by an insurer for denial of a claim shall not act as an estoppel or limit the insurer […]
(a) This section applies to insurers and nonprofit health service plans that propose to issue or deliver individual, group, or blanket health insurance policies or contracts or to administer health benefit programs that provide hospital, medical, or surgical benefits on an expense–incurred basis. (b) Each entity subject to this section shall provide to an insured individual who […]
(a) (1) In this section the following words have the meanings indicated. (2) “Carrier” means: (i) an insurer; (ii) a nonprofit health service plan; (iii) a health maintenance organization; (iv) a dental plan organization; (v) a managed care organization, as defined in § 15–101 of the Health – General Article; or (vi) any other person that provides health benefit plans subject to regulation by […]
(a) In this section, “carrier” means: (1) an insurer; (2) a nonprofit health service plan; (3) a health maintenance organization; (4) a dental plan organization; or (5) any other person that provides health benefit plans subject to regulation by the State. (b) If a health care service for a patient has been preauthorized or approved by a carrier or the carrier’s private […]
(a) (1) In this section the following words have the meanings indicated. (2) “Adverse benefit determination” means: (i) a denial, reduction, or termination of a disability benefit; (ii) a failure to provide or make payment, in whole or in part, for a disability benefit; or (iii) any denial, reduction, termination, or failure to provide or make payment that is based on […]
(a) (1) This section applies to: (i) insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense–incurred basis under health insurance policies or contracts that are issued or delivered in the State; and (ii) health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under […]
