INSURANCE WATCH

MedChi, the Maryland State Medical Society, is a non-profit membership association representing thousands of Maryland physicians. Our mission is to serve as Maryland’s foremost advocate and resource for physicians, their patients, and public health.

A 2010 MedChi survey of Maryland doctors explored the impact of health insurance protocols on the ability of Maryland physicians to provide effective care. The survey revealed near universal dissatisfaction with health insurer requirements and the ways in which the requirements dictate how doctors treat patients. Insurance practices such as requiring pre-approval for medical procedures and prescription medications, step therapy, and therapeutic substitution deny patients access to care and are tantamount to practicing medicine without a license.

MedChi established Insurance Watch to help Maryland physicians register complaints with the Maryland Attorney General about health insurer practices that jeopardize patient health and interfere with care. For more information about Insurance Watch please contact us at (410) 539-0872.

Step 1: File a Complaint

When coverage of a patient's medical care is denied, whether prospectively or retroactively, Maryland health care providers may file a complaint on behalf of their patient with the Office of the Attorney General's Health Education and Advocacy Unit ("HEAU") or the Maryland Insurance Administration ("MIA").

If you are a provider and want assistance with an internal appeal or want to file a complaint with the HEAU, Click Here.

If you wish to file a complaint concerning health insurance, or for assistance with an emergency appeal of a denied health care service, contact the MIA, Click Here.

If the complaint is misfiled, it will be redirected to the proper agency.

Broader issues, such as claims processing time, pre-authorization practices and other related market conduct, are investigated by the Maryland Insurance Administration based upon specific complaints received by the agency. Such complaints should be directed to the Maryland Insurance Administration.  For patients who are covered under an employer self-funded plan, contact the U.S. Department of Labor; or for patients who are federal employees, contact the Office of Personnel Management.

Step 2: Have MedChi Track Your Complaint & Notify Your Legislators

Fill out the information below if you’d like to have MedChi follow up with the Attorney General’s office to track the status of your complaint.

Complaint Information

Hospital/Medical Practice:
Protecting physicians’ ability to treat patients without insurer interference will also require legislative action, because far too many of the protocols insurers use to delay or deny coverage to patients are still completely legal in the state of Maryland.

IMPORTANT NOTICE:
This website may contain information regarding general principles of law. It is not intended as legal advice and cannot be substituted for such. Use of this web site shall not and does not create an attorney-client relationship between users of this site and MedChi, The Maryland State Medical Society, and any of its employees, contractors, or other associates. For advice regarding a specific legal situation you must retain an attorney licensed in the applicable jurisdiction and with appropriate training and/or experience in the legal area in question.

Additional Resources

Maryland Attorney General - Health Education and Advocacy Unit

1 (877) 261-8807
Fax: (410) 576-6571
http://www.oag.state.md.us/consumer/heau.htm

Maryland Insurance Commissioner

Therese Goldsmith, Maryland Insurance Administration
200 St. Paul Place, Suite 2700
Baltimore, MD 21202
(410) 468-2000
Email: miaweb@mdinsurance.state.md.us
Web: www.mdinsurance.state.md.us

MedChi, The Maryland State Medical Society

1 (800) 492-1056, ext. 3312
www.medchi.org

Medicaid

For inquiries about HealthChoice – Maryland’s statewide mandatory managed care program (access & quality of care issues):
Enrollee Action Line
1 (800) 284-4510
TDD: (800) 735-2258
For information and answers to common questions concerning different Maryland programs and services, visit: http://mmcp.dhmh.maryland.gov/SitePages/Frequently%20Asked%20Questions%20List.aspx
Enrollment Issues
1 (800) 977-7388
TDD: (800) 977-7389
Provider Hotline 1 (800) 766-8692 or
(410) 767-5340
General Information 1 (877) 463-3464
For general information on Maryland’s Department of Health and Mental Hygiene, visit: www.dhmh.state.md.us

Maryland Insurance Administration

An independent State agency that regulates Maryland’s insurance industry
1 (800) 492-6116
Fax : (410) 468-2270
www.mdinsurance.state.md.us

To file a complaint with the American Medical Association:

The AMA offers numerous ways for physicians to register their complaints about health insurers and other payers. Physicians can utilize the following tools:

State Department of Insurance complaint forms and State Medical Association complaint processes.

Health Plan Complaint Form Use the AMA Health Plan Complaint Form to let the AMA know about the hassles and unfair business practices you experience in your day-to-day interactions with health insurers.

To access the MD site directly, click here: Maryland.

For more information about the MedChi physician survey, click here.

Maryland Rx Card

To download the Maryland Rx Card, which provides savings of up to 75% on prescription drugs at local pharmacies, click here.

Your Advocate.
Your Resource.
Your Profession.