If a health insurer refuses to pay a bill in Maryland, what do you do? In 1998, the Maryland General Assembly at the urging of MedChi passed the “Appeals and Grievance Law” (Health General 19-705.2 and Commercial Law Articles 12-4A-04 and 13-4A-02) to assist patients in appealing adverse decisions made by their insurance companies. The law empowers two different state agencies to assist patients when they feel they have been denied coverage for needed medical care. Most of the cases that are referred to these agencies are decided in favor of the patient.
The Appeals and Grievance Law was passed in response to concerns expressed by the physician community and the public that necessary medical services were being denied. Under the law, carriers must provide their members with a written copy of an adverse decision within five days of its being made. The decision must clearly state the exact factual basis for the carrier’s decision, including the specific criteria the company used in making its decision. .
Patients may utilize the Health Education and Advocacy Unit of the Maryland Attorney General’s Office to assist them in filing this grievance with the carrier. The number to call for this assistance is 1-877-261-8807. If the insurance carrier still refuses to pay for the medical care, the patient may then file an appeal with the Maryland Insurance Administration (MIA) at 1-800-492-6116.
From June 1 MedChi News