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Session Laws, 2000
Volume 797, Page 1634   View pdf image
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Ch. 275
2000 LAWS OF MARYLAND
authority to operate in this State shall not be liable to any health care provider for
any covered services provided to the enrollee or subscriber. (2) (i) A health care provider or any representative of a health care
provider may not collect or attempt to collect from any subscriber or enrollee any
money owed to the health care provider by a health maintenance organization issued
a certificate of authority to operate in this State. (ii) A health care provider or any representative of a health care
provider may not maintain any action against any subscriber or enrollee to collect or
attempt to collect any money owed to the health care provider by a health
maintenance organization issued a certificate of authority to operate in this State. (3) Notwithstanding any other provision of this subsection, a health care
provider or representative of a health care provider may collect or attempt to collect
from a subscriber or enrollee: (i) Any copayment or coinsurance sums owed by the subscriber or
enrollee to a health maintenance organization issued a certificate of authority to
operate in this State for covered services provided by the health care provider; -tor-} (ii) Any payment or charges for services not covered under the
subscriber's contract; OR (III) ANY PAYMENT OR CHARGES FOR COVERED SERVICES UNDER §
19-719.1(D) OF THIS SUBTITLE.
SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland
read as follows: Article - Health - General 19-710.1. (a) (1) In this section the following words have the meanings indicated. (2) "Enrollee" means a subscriber or member of the health maintenance
organization. (3) "Covered service" means a health care service included in the benefit
package of the health maintenance organization and rendered to an enrollee of the
health maintenance organization by a health care provider, including a physician or
hospital, not under written contract with the health maintenance organization: (i) Pursuant to a verbal or written referral by the enrollee's health
maintenance organization or by a provider under written contract with the enrollee's
health maintenance organization; or (ii) That has been preauthorized or otherwise approved either
verbally or in writing by the enrollee's health maintenance organization or a provider
under written contract with the enrollee's health maintenance organization.
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Session Laws, 2000
Volume 797, Page 1634   View pdf image
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