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31.10.29.00.htm 31.10.29.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 10 HEALTH INSURANCE ― GENERAL Chapter 29 Complaint Process for Coverage Decisions Authority: Insurance Article, §15-10D-02(d) and 15-10D-04, Annotated Code of Maryland
31.10.29.01.htm 31.10.29.01. 01 Scope.. This chapter applies to carriers and representatives of carriers making coverage decisions..
31.10.29.02.htm 31.10.29.02. 02 Definitions.. A. In this chapter, the following terms have the meaning indicated.. B. Terms Defined.. 1) "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.2) "Appeal decision" means a final determination by a carrier that arises from an appeal filed with the carrier under its appeal process regarding a coverage decision concerni
31.10.29.03.htm 31.10.29.03. 03 Exhaustion of Internal Appeal Process.. A. Except as provided in §B of this regulation, the carrier's internal appeal process shall be exhausted before filing a complaint with the Commissioner under this chapter.B. In a case involving a prospective denial, a member, a member’s representative, or a health care provider filing a complaint on behalf of a member may file a complaint with the Commissioner without first filing an appeal with a carrier and receivin
31.10.29.9999.htm 31.10.29.9999. Administrative History Effective date: June 10, 2002 (29:11 Md. R. 891). Regulation .02B amended effective April 16, 2012 (39:7 Md. R. 497). Regulation .03B, C amended effective April 16, 2012 (39:7 Md. R. 497).
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