Maryland Insurance Protections
What can I do if I can’t find a provider in my insurance network?
Maryland law entitles consumers to, “access to primary and specialty care without unreasonable delay or travel.” This means your insurance company must maintain an adequate network of providers to ensure that you do not have to wait extended time for an appointment or travel long distances.
If you are having difficulty getting an appointment with an in-network mental health provider, there are steps you can take before you resign yourself to going out of network for care. Ask your insurance company to give you the contact information for a few providers who are accepting new patients and available for appointments in the next few weeks. If they are unable to do this, you can request that they provide a special case agreement, allowing you to visit an out of network provider, but at in-network cost, which could save you hundreds of dollars. If you are still unable to find an in-network provider, you can lodge a complaint with the Maryland Insurance Administration.
Are there protections if I change my insurance plan?
As of 2015, all insurers in Maryland are required to provide continuity of care provisions for individuals who are transitioning from one plan or MCO to another. These 90-day provisions will enable individuals to carry a prior authorization for a current course of treatment with them to the new plan, as well as, allow an individual to continue to see their current provider at in-network cost-sharing even if that provider does not participate with the new insurance plan.
If your insurer doesn’t honor this, you should contact the Maryland Insurance Administration.
10 Things You Should Know About the Mental Health Parity Law
1. Current regulations went into effect in January of 2010.
The Wellstone and Domenici Mental Health Parity and Addiction Equity Act was passed in 2008, but Interim Final Regulations were released in 2010. All insurance plans that are not specifically exempted from the law must now be in compliance.