Health Insurance - Retroactive Denial of Reimbursement

HB 917 limits when health insurance companies in Maryland can deny payment for past medical services (retroactive denial of reimbursement). It restricts such denials to cases involving coordination of benefits within 18 months of payment or after insurers provide providers with training on billing standards within 3 months. The bill requires insurers to give providers written explanations with supporting details for any denial and prohibits denials based on service outcomes or without first discussing the circumstances with the provider. It also mandates that insurers developing retroactive denial policies create training plans for healthcare providers on reimbursement protocols. The law applies to all insurance policies effective January 1, 2027.