Maryland's Surprise Billing Protection Act (effective January 1, 2022) aligns with the federal No Surprises Act. HB 978 (effective October 1, 2023) additionally prohibits AI-only claim and prior authorization denials—all adverse determinations require human clinical review.
Emergency Care and In-Network Rates
Emergency services trigger in-network cost-sharing protections regardless of provider network status. Patients pay only their in-network deductible, copay, and coinsurance amounts. Insurers pay OON emergency providers at rates negotiated for the specific service and region.
Scheduled Services at In-Network Facilities
Planned procedures at in-network facilities performed by OON providers are protected unless the patient explicitly consents to OON rates. Written consent is required at least 72 hours before the scheduled service. Without advance written consent, patients pay only in-network cost-sharing.
Good Faith Estimates and Advance Notice
Providers must supply Good Faith Estimates for all scheduled services. Insurers must provide 72-hour advance notice if OON providers may be involved in a scheduled service. This advance notification gives patients time to seek alternatives or provide informed consent.
HB 978: Human Clinical Review Requirement
Maryland HB 978 (effective October 1, 2023) bans AI-only claim and prior authorization denials. All adverse determinations—whether claim denials or PA denials—require human clinical review by a qualified healthcare provider. This protects against automated denials based solely on algorithmic decision-making.
Enforcement and Oversight
The Maryland Insurance Administration enforces state protections. Federal CMS enforces the No Surprises Act for ERISA self-funded plans. The layered system ensures all Maryland residents receive comparable surprise billing protections.
Ensure compliance with Maryland's surprise billing and human review requirements using Altair's integrated tools.
Frequently Asked Questions
Does Maryland's surprise billing law cover ground ambulance?
Ground ambulance is covered under Maryland's surprise billing protections only in emergency situations. Non-emergency transport may not be covered depending on plan design.
Can I consent to higher out-of-network charges in Maryland?
Only for scheduled non-emergency services. You must provide written consent at least 72 hours before the service to waive surprise billing protections for OON charges at in-network facilities.
Related Resources
- Maryland Balance Billing Law
- Maryland Timely Filing Requirements
- All State Billing Laws
- No Surprises Act Overview