Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult a qualified attorney to address your specific situation.
Detailed Answer
Under Maryland law, no rule called “Rule 414” exists that would allow an insurance adjuster to unilaterally reduce your medical bills. North Carolina Rule 414 relates to evidence of past sexual conduct and has no application to billing or insurance practices in Maryland. Insurance companies and adjusters in Maryland must follow state statutes and regulations governing reimbursement and billing.
Maryland Insurance Reimbursement Standards
Maryland’s Insurance Article § 19-509 requires insurers—including personal injury protection (PIP) carriers and no-fault auto insurers—to pay “reasonable charges” for covered medical services. An adjuster cannot apply an out-of-state evidence rule to override this statutory requirement. Instead, carriers rely on fee schedules or usual, customary and reasonable (UCR) rates to determine payment amounts:
- Maryland Insurance Article § 19-509(a)(1): Insurer must pay reasonable charges for services rendered by a licensed provider. View § 19-509
Maryland’s Collateral Source Rule
Maryland follows the collateral source rule, preventing an insurer or defendant from reducing your recoverable damages simply because you received payment from another source (e.g., health insurance). Maryland Courts & Judicial Proceedings § 11-110 states:
- Payments or benefits from a collateral source are not deductible from the plaintiff’s recovery. View § 11-110
Negotiation vs. Unilateral Reductions
While insurers cannot unilaterally slash your bills under a foreign evidence rule, they often negotiate discounts directly with medical providers when you assign your insurance benefits to them. Key points:
- Assignment of benefits allows the insurer to pay providers directly at negotiated rates.
- You retain the right to challenge unreasonable fee schedules or payment denials through Maryland’s administrative appeal processes or court action.
Helpful Hints
- Review your insurance policy’s definitions of “reasonable and customary charges.”
- Ask your provider for an itemized bill and compare it to UCR databases.
- Sign an assignment of benefits only after understanding any discounts or write-offs.
- Document all communications with your insurer and medical providers.
- If your carrier denies or underpays, consider filing an appeal with the Maryland Insurance Administration.
- Consult a Maryland-licensed attorney if you need help enforcing your rights.