Waiver for Services Provided by Non-contracting Physicians

On November 21, 2001, Attorney General Joseph Curran issued and opinion outlining the circumstances under which a physician or other health care provider may eschew the HMO process and bill an HMO member for services rendered.  Attorney General Curran ruled that under Maryland law, an HMO patient can arrange to receive services from a physician not part of an HMO, in which case the services will be deemed to be non-covered.  Under these circumstances and following the guidelines outlined by Curran, the physician is allowed to bill the patient at his or her usual rate. 

The attorney-general states that, "It is vital...that the patient's intent not to access the provider through the HMO and the patient's knowledge of the consequences of that decision be adequately documented at the time of the patient and the provider enter into a private contract. 

To demonstrate the patient's intent and knowledge, the physician must provide the patient with a written document  that "clearly and concisely informs the member of the final consequences of entering into a private contract outside the context of the HMO."

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