Health Insurance - Adverse Decisions - Notices, Reporting, and Examinations

HB 848 requires Maryland health insurance carriers to submit quarterly reports to the Insurance Commissioner detailing adverse decisions (denials of coverage), including specific data on denied claims, grievance outcomes, and emergency case processing times. If a carrier’s adverse decisions for a specific service type rise by more than 10% annually or 25% over three years, they must also report the reasons for the increase, such as changes in medical management. The Commissioner will compile annual summary reports from this data and may use it to initiate examinations of carriers. This bill directly affects health insurance carriers operating in Maryland, aiming to increase transparency around coverage denials without altering coverage rules.