§ 13-4A-02. Duties

   (a) Implementation of educational and advocacy program. -- The Unit may implement an educational and advocacy program designed to:

   (1) Enable health care consumers to make more informed choices in the health marketplace, and to be able to participate in decisions concerning their health care; and

   (2) Otherwise promote the interest of health consumers in the health marketplace.

(b) Assistance to health care consumers. --

   (1) (i) The Unit may assist health care consumers in understanding their health care bills and third party coverage, in identifying improper billing or coverage determinations, and in reporting any billing or coverage problems to appropriate entities, including the Division, the Attorney General or other governmental agencies, insurers, or providers.

      (ii) Whenever the Unit requests information from an insurer, nonprofit health service plan, or health maintenance organization in order to assist a health care consumer for the purposes provided in this paragraph, the insurer, nonprofit health service plan, or health maintenance organization shall provide the information to the Unit no later than 7 working days from the date the insurer, nonprofit health service plan, or health maintenance organization received the request.

   (2) Whenever any billing or coverage question concerns the adequacy or propriety of any services or treatment, the Unit shall refer the matter to an appropriate professional, licensing, or disciplinary body, as applicable. The Unit may monitor the progress of the concerns raised by health consumers through such referrals.

   (3) Whenever any billing or coverage question concerns a matter within the jurisdiction of the Insurance Commissioner, the Unit shall refer the matter to the Commissioner. The Unit may monitor the progress of the concerns raised by health consumers through such referrals.

   (4) The Unit shall work with the Department of Health and Mental Hygiene to assist with resolving any billing or coverage questions as necessary.

(c) Recommendations to Attorney General, Governor, General Assembly, etc.; duty to provide information. -- The Unit may:

   (1) Recommend to the Attorney General, the Governor, the General Assembly, or other appropriate governmental agencies any measures that will promote the interests of health consumers in the health marketplace; and

   (2) Present for consideration relevant information on the effects on health care consumers generally in any agency proceeding which is otherwise open to the public.

(d) Bringing certain civil actions prohibited. -- Nothing in this section shall mean that the Unit may have authority to bring any civil action seeking review of a State agency determination.

HISTORY: 1986, chs. 296, 565; 1990, ch. 450; 1998, ch. 111, § 2; ch. 112, § 2.