Maryland SB 1108 and HB 1678, effective January 1, 2022, prohibit balance billing when out-of-network providers deliver emergency services or scheduled non-emergency services at in-network facilities. Patients pay only in-network cost-sharing amounts regardless of provider network status.
Protected Services Under Maryland SB 1108
The law covers two categories of protected services:
- Emergency services: Any emergency care rendered by any provider, in or out of network
- Non-emergency scheduled services: Planned procedures at in-network facilities performed by OON providers
In both cases, patients pay only their in-network cost-sharing (deductible, copay, coinsurance). The insurer pays the OON provider directly at the negotiated in-network rate. Patients are not liable for the difference between OON and in-network charges.
How Balance Billing Protection Works
When an OON provider delivers covered services, the billing obligation flows to the insurer, not the patient. The insurer must pay the OON provider at the applicable in-network contracted rate. This creates a direct insurer-to-provider billing relationship, removing the patient from financial exposure for OON charges.
Dispute Resolution and Enforcement
If a patient receives a balance bill for a covered service, the insurer and provider have 30 days to negotiate a resolution. If unresolved, arbitration may be initiated. The Maryland Insurance Administration enforces SB 1108 through complaint investigations and can take regulatory action against non-compliant carriers.
Federal vs. State Coverage
Maryland's SB 1108 applies to state-regulated health plans. ERISA self-funded plans are governed by the federal No Surprises Act. However, for state-regulated plans, Maryland law often provides equivalent or greater protections.
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Frequently Asked Questions
Does Maryland's balance billing law cover all out-of-network care?
No. Maryland SB 1108 covers emergency services and non-emergency scheduled services performed by OON providers at in-network facilities. Services at OON facilities or unscheduled OON services at non-facility settings are not covered.
What happens if a provider violates Maryland balance billing law?
The Maryland Insurance Administration enforces SB 1108. Violations can trigger complaints, investigations, and enforcement actions against the carrier. Patients can file complaints with MIA if denied in-network protections.
Related Resources
- Maryland Timely Filing Requirements
- Maryland Surprise Billing Protection Act
- All State Billing Laws
- Balance Billing Law Overview