{"data":{"id":"us-md/md.-code-insurance-15-10b-17","jurisdiction":"us-md","citation":"Md. Code, Insurance § 15–10B–17","heading":"","body":"(a) (1) Except as provided in paragraph (2) of this subsection, this section does not apply to:\n(i) a private review agent referring an individual to a health care provider or facility that participates in a health maintenance organization;\n(ii) a preferred provider organization network of participating health care providers or facilities to which the individual would otherwise be referred as part of the individual’s membership or insurance contract; or\n(iii) an employee assistance program referring an individual to a network of participating health care providers or facilities in accordance with a contract with the individual’s employer or labor union to provide comprehensive mental health and substance abuse services.\n(2) A private review agent or any other individual who is either affiliated with, under contract with, or acting on behalf of a private review agent may not approve or fail to approve a course of treatment based on whether the treatment is delivered by a provider who is a participating or nonparticipating provider in the preferred provider organization or employee assistance program network.\n(b) A private review agent or any individual who is either affiliated with, under contract with, or acting on behalf of a private review agent may not:\n(1) refer a patient who has undergone utilization review by the private review agent to:\n(i) a health care facility in which the private review agent owns a significant beneficial interest; or\n(ii) the private review agent’s own health care practice;\n(2) pay or agree to pay any sum to, or accept or agree to accept any sum from, any person for bringing or referring a patient to the private review agent; or\n(3) provide for different insurance coverage or benefits based on receiving the service from a health care facility or health care provider in which the private review agent owns a significant beneficial interest.\n(c) A private review agent or any individual who is either affiliated with, under contract with, or acting on behalf of a private review agent may refer a patient who has undergone utilization review by the private review agent to another health care provider regulated under the Health Occupations Article if:\n(1) (i) the patient or provider requests the private review agent to provide the patient with the name of a health care provider appropriate to meet the health care needs of the patient; or\n(ii) the patient has no attending physician; and\n(2) the private review agent provides the patient with the names of at least two health care providers appropriate to meet the health care needs of the patient.","path":["Article - Insurance"],"source_url":"https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gin\u0026section=15-10B-17","current_through":"2026-01-01","vintage":"","retrieved_at":"2026-09-14T19:59:28Z","sha256":"c020fb302f0e67b10009f9349dc155cbb07b31c9b501006247b0141fe5baa1ce","source_id":"us-md","stale":false,"prev":"us-md/md.-code-insurance-15-10b-16","next":"us-md/md.-code-insurance-15-10b-18"},"notice":"GroundRules: Original legal text. Not legal advice."}