(a) In this subtitle the following words have the meanings indicated. (b) “Appeal” means a protest filed by a member, a member’s representative, or a health care provider with a carrier under its internal appeal process regarding a coverage decision concerning a member. (c) “Appeal decision” means a final determination by a carrier that arises from an appeal […]
(a) (1) Each carrier shall establish an internal appeal process for use by its members, its members’ representatives, and health care providers to dispute coverage decisions made by the carrier. (2) The carrier may use the internal grievance process established under Subtitle 10A of this title to comply with the requirement of paragraph (1) of this subsection. (b) A […]
(a) It is a violation of this subtitle for a carrier to fail to fulfill the carrier’s obligations to provide or reimburse for health care services specified in the carrier’s policies or contracts with members. (b) If, in rendering a coverage decision or appeal decision, a carrier fails to fulfill the carrier’s policies or contracts with members, […]
The Commissioner may adopt any necessary regulations to carry out the provisions of this subtitle.
A carrier shall provide the notices required to be provided to members under this subtitle in a culturally and linguistically appropriate manner as described in the Affordable Care Act.
