§ 15-819. Coverage for outpatient services and second opinions

   (a) Scope of section. -- This section applies to:

   (1) each individual, group, or blanket health insurance policy that is issued or delivered in the State by an insurer; and

   (2) each contract or certificate that is issued or delivered in the State by a nonprofit health service plan.

(b) Coverage required. -- A policy, contract, or certificate subject to this section that provides coverage for an inpatient service in an acute general hospital shall provide coverage for:

   (1) a corresponding outpatient service that is provided to the insured instead of the inpatient service because of the denial, after review under a utilization review program, of a request by the attending physician for an inpatient admission; and

   (2) an objective second opinion given to the insured when required by a utilization review program under § 19-319 of the Health - General Article.

HISTORY: An. Code 1957, art. 48A, § 354CC, 470V, 477DD; 1997, ch. 35, § 2.