§ 15-138. Direct reimbursement to ambulance service providers
West's Annotated Code of MarylandInsuranceEffective: June 1, 2015
Effective: June 1, 2015
MD Code, Insurance, § 15-138
§ 15-138. Direct reimbursement to ambulance service providers
(b) This section applies to individual or group policies or contracts issued or delivered in the State by a carrier.
(c)(1) Except for a health maintenance organization, a carrier shall reimburse directly an ambulance service provider that obtains an assignment of benefits from an insured, a subscriber, or an enrollee for covered services provided to the insured, subscriber, enrollee, or any other individual covered by a policy or contract issued by the carrier.
(d)(1) This subsection applies to an ambulance service provider that receives direct reimbursement under subsection (c) of this section.
(ii) if Medicare is the primary insurer and the carrier is the secondary insurer, any amount up to the Medicare-approved or limiting amount, as specified under the federal Social Security Act, that is not owed to the ambulance service provider by Medicare or the carrier after coordination of benefits has been completed, for Medicare covered services rendered to the insured, subscriber, or enrollee by the ambulance service provider; and
Health maintenance organization’s allowed amount for service provided by an ambulance service provider
(e)(1) Notwithstanding § 19-710.1 of the Health--General Article, a health maintenance organization's allowed amount for a covered health care service provided by an ambulance service provider that is not under written contract with the health maintenance organization may not be less than the allowed amount paid to an ambulance service provider that is under written contract with the health maintenance organization for the same covered service in the same geographic region, as defined by the Centers for Medicare and Medicaid Services.
(2) An insurer's or nonprofit health service plan's allowed amount for a health care service covered under a preferred provider insurance policy and provided by an ambulance service provider that is a nonpreferred provider may not be less than the allowed amount paid to an ambulance service provider who is a preferred provider for the same health care service in the same geographic region, as defined by the Centers for Medicare and Medicaid Services.
Credits
Added by Acts 2011, c. 425, § 1, eff. Jan. 1, 2012; Acts 2011, c. 426, § 1, eff. Jan. 1, 2012. Amended by Acts 2015, c. 434, § 1, eff. June 1, 2015.
MD Code, Insurance, § 15-138, MD INSURANCE § 15-138
Current with all legislation from the 2023 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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