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2000 LAWS OF MARYLAND
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Ch. 371
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1. THAT THE MEMBER HAS A RIGHT TO FILE A COMPLAINT
WITH THE COMMISSIONER WITHIN 30 DAYS AFTER RECEIPT OF A CARRIER'S APPEAL
DECISION;
2. THAT A COMPLAINT MAY BE FILED WITHOUT FIRST
FILING AN APPEAL IF THE MEMBER OR A HEALTH CARE PROVIDER FILING AN
APPEAL ON BEHALF OF THE MEMBER CAN DEMONSTRATE A COMPELLING REASON
TO DO SO; AND
3. THE COMMISSIONERS ADDRESS, TELEPHONE NUMBER,
AND FACSIMILE NUMBER
(E) (1) WITHIN 30 CALENDAR DAYS AFTER A COVERAGE DECISION HAS
BEEN MADE, A CARRIER SHALL SEND A WRITTEN NOTICE OF THE COVERAGE
DECISION TO THE MEMBER AND, IN THE CASE OF A HEALTH MAINTENANCE
ORGANIZATION, THE TREATING HEALTH CARE PROVIDER.
(2) NOTICE OF THE COVERAGE DECISION REQUIRED TO BE SENT UNDER
PARAGRAPH (1) OF THIS SUBSECTION SHALL:
(I) STATE IN DETAIL IN CLEAR, UNDERSTANDABLE LANGUAGE,
THE SPECIFIC FACTUAL BASES FOR THE CARRIER'S DECISION; AND
(II) INCLUDE THE FOLLOWING INFORMATION:
1. THAT THE MEMBER OR A HEALTH CARE PROVIDER
ACTING ON BEHALF OF THE MEMBER HAS A RIGHT TO FILE AN APPEAL WITH THE
CARRIER;
2. THAT THE MEMBER OR A HEALTH CARE PROVIDER
ACTING ON BEHALF OF THE MEMBER, MAY FILE A COMPLAINT WITH THE
COMMISSIONER WITHOUT FIRST FILING AN APPEAL, IF THE COVERAGE DECISION
INVOLVES AN URGENT MEDICAL CONDITION FOR WHICH CARE HAS NOT BEEN
RENDERED; AND
3. THE COMMISSIONER'S ADDRESS, TELEPHONE NUMBER,
AND FACSIMILE NUMBER;
4. THAT THE HEALTH ADVOCACY UNIT IS AVAILABLE TO
ASSIST THE MEMBER IN BOTH MEDIATING AND FILING AN APPEAL UNDER THE
CARRIER'S INTERNAL APPEAL PROCESS; AND
5. THE ADDRESS, TELEPHONE NUMBER, FACSIMILE
NUMBER, AND EMAIL ADDRESS OF THE HEALTH ADVOCACY UNIT.
(F) (1) WITHIN 30 CALENDAR DAYS AFTER THE APPEAL DECISION HAS BEEN
MADE, EACH CARRIER SHALL SEND TO THE MEMBER AND THE HEALTH CARE
PROVIDER ACTING ON BEHALF OF THE MEMBER, A WRITTEN NOTICE OF THE APPEAL
DECISION.
(2) NOTICE OF THE APPEAL DECISION REQUIRED TO BE SENT UNDER
PARAGRAPH (1) OF THE SUBSECTION SHALL:
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- 2110 -
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