Md. Code, Ins. § 15-10B-07. Adverse decisions and appeals: Private Review Agents – Maryland

Status: Enacted
Year Enacted: 2000
File: Download

Except as provided in paragraphs (2) and (3) of this subsection, all adverse decisions shall be made by a physician, or a panel of other appropriate health care service reviewers with at least one physician on the panel who is board certified or eligible in the same specialty as the treatment under review. A private review agent may only retrospectively render an adverse decision regarding preauthorized or approved services delivered to a patient if the information submitted to the private review agent regarding the services to be delivered to the patient was fraudulent or intentionally misrepresentative; critical information requested by the private review agent regarding services to be delivered to the patient was omitted such that the private review agent’s determination would have been different had the agent known the critical information; or the planned course of treatment for the patient that was approved by the private review agent was not substantially followed by the provider

Return to Database Search

© 2018- The SLIHCQ DatabaseInitial funding for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

Associated Litigation:

No items found