Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 10 - HEALTH INSURANCE-GENERAL
Chapter 31.10.18 - Denials of Coverage Based on Medical Necessity
Section 31.10.18.05 - Procedures for Emergency Cases
Universal Citation: MD Code Reg 31.10.18.05
Current through Register Vol. 51, No. 19, September 20, 2024
A. An expedited review of an adverse decision in accordance with this regulation is required if the:
(1) Adverse decision is rendered for health care services that are proposed but have not been delivered; and
(2) Services are necessary to treat a condition or illness that, without immediate medical attention, would:
(a) Seriously jeopardize the life or health of the member of the member's ability to regain maximum functions;
(b) Cause the member to be in danger to self or others; or
(c) Cause the member to continue using intoxicating substances in an imminently dangerous manner.
B. The content of any written notice by a carrier of an adverse decision or grievance decision under this regulation shall comply with Regulation .04 of this chapter and Insurance Article, § 15-10 A-02(f) and (i), Annotated Code of Maryland.
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