Bill > HB917

This bill modifies the rules for when health insurance carriers, which are companies that provide health insurance, can take back money they have already paid to healthcare providers for services rendered. Specifically, a carrier can only retroactively deny reimbursement, meaning they can only ask for money back after it's been paid, under limited circumstances: either if the denial is for services that should have been covered by another insurance plan or government program like Medicare, and this denial happens within 18 months of the initial payment, or if the carrier has already trained the provider on billing rules and the denial occurs within 3 months of the service being provided. When a carrier does deny reimbursement retroactively, they must provide the provider with a written explanation including supporting documents and calculations, and if another entity is responsible for the payment, their information must be included. The bill also prohibits carriers from denying reimbursement based solely on the outcome of a service or without first discussing the situation with the healthcare provider and considering their explanation. Furthermore, carriers that retroactively deny reimbursement are required to develop a training plan for healthcare providers on proper billing and reimbursement procedures. This legislation will apply to insurance policies and plans issued or renewed on or after January 1, 2027.

Health and Social Services

https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/HB0917?ys=2026RS