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§ 15-10D-03. Failure of carrier to fulfill obligations to provide or reimburse for health care ...

West's Annotated Code of MarylandInsurance

West's Annotated Code of Maryland
Insurance (Refs & Annos)
Title 15. Health Insurance
Subtitle 10d. Complaint Process for Coverage Decisions (Refs & Annos)
MD Code, Insurance, § 15-10D-03
§ 15-10D-03. Failure of carrier to fulfill obligations to provide or reimburse for health care services
Currentness
Violation of subtitle
(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.
Actions by Commissioner
(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:
(1) issue an administrative order that requires the carrier to:
(i) cease inappropriate conduct or practices by the carrier or any of the personnel employed or associated with the carrier;
(ii) fulfill the carrier's contractual obligations;
(iii) provide a health care service or payment that has been denied improperly; or
(iv) take appropriate steps to restore the carrier's ability to provide a health care service or payment that is provided under a contract; or
(2) impose any penalty or fine or take any action as authorized:
(i) for an insurer, nonprofit health service plan, or dental plan organization, under this article; or
(ii) for a health maintenance organization, under the Health-General Article or under this article.

Credits

Added by Acts 2000, c. 371, § 2, eff. Jan. 1, 2001.
MD Code, Insurance, § 15-10D-03, MD INSURANCE § 15-10D-03
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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