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2000 LAWS OF MARYLAND
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Ch. 371
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(III) 3. THE COMMISSIONER'S ADDRESS, TELEPHONE NUMBER,
AND FACSIMILE NUMBER; AND
4. A STATEMENT THAT THE HEALTH ADVOCACY UNIT IS
AVAILABLE TO ASSIST THE MEMBER IN BOTH MEDIATING AND FILING A GRIEVANCE
UNDER THE CARRIER'S INTERNAL GRIEVANCE PROCESS; AND
5. THE ADDRESS, TELEPHONE NUMBER, FACSIMILE
NUMBER, AND EMAIL ADDRESS OF THE HEALTH ADVOCACY UNIT.
(6) INCLUDES THE FOLLOWING DISCLOSURE IN AT LEAST 12 POINT
TYPEFACE, WITH THE FIRST SENTENCE IN BOLD CAPITAL TYPEFACE:
"THERE IS HELP AVAILABLE TO YOU IF YOU WISH TO DISPUTE THE DECISION
OF THE PLAN ABOUT PAYMENT FOR HEALTH CARE SERVICES. YOU MAY CONTACT
THE HEALTH ADVOCACY UNIT OF MARYLAND'S CONSUMER PROTECTION DIVISION
AT (PHONE NUMBER, ADDRESS, FAX, E-MAIL).
THE HEALTH ADVOCACY UNIT CAN HELP YOU AND YOUR HEALTH CARE
PROVIDER PREPARE A GRIEVANCE TO FILE UNDER THE CARRIER'S INTERNAL
GRIEVANCE PROCEDURE. THAT UNIT CAN ALSO ATTEMPT TO MEDIATE A
RESOLUTION TO YOUR DISPUTE. THE HEALTH ADVOCACY UNIT IS NOT AVAILABLE
TO REPRESENT OR ACCOMPANY YOU DURING ANY PROCEEDING OF THE INTERNAL
GRIEVANCE PROCESS.
ADDITIONALLY, YOU MAY FILE A COMPLAINT WITH THE MARYLAND
INSURANCE ADMINISTRATION, WITHOUT HAVING TO FIRST FILE A GRIEVANCE WITH
THE PLAN, IF;
(1) THE PLAN HAS DENIED AUTHORIZATION FOR A HEALTH CARE
SERVICE NOT YET PROVIDED TO YOU; AND
(2) YOU OR YOUR PROVIDER CAN SHOW A COMPELLING REASON TO FILE
A COMPLAINT, INCLUDING THAT A DELAY IN RECEIVING THE HEALTH CARE SERVICE
COULD RESULT IN LOSS OF LIFE, SERIOUS IMPAIRMENT TO A BODILY FUNCTION, OR
SERIOUS DYSFUNCTION OF A BODILY ORGAN OR PART, OR THE MEMBER REMAINING
SERIOUSLY MENTALLY ILL WITH SYMPTOMS THAT CAUSE THE MEMBER TO BE A
DANGER TO SELF OR OTHERS. INFORMATION DESCRIBED IN THIS NOTICE MAY ALSO
BE FOUND IN (CITE POLICY, PLAN, CERTIFICATE, ENROLLMENT MATERIALS, OR
OTHER EVIDENCE OF COVERAGE)."
(i) [(1) For nonemergency cases, each carrier's internal grievance process
established under subsection (a) of this section shall include a provision that requires
the carrier to:
(i) document in writing any adverse decision or grievance decision
made by the carrier after the carrier has provided oral communication of the decision
to the member or the health care provider who filed the grievance on behalf of the
member; and
(ii) within 5 working days after the decision has been made, send
notice of the adverse decision or grievance decision to:
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- 2104 -
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