Disclaimer: This article is for educational purposes only and does not constitute legal advice. Consult a licensed attorney regarding your specific situation.
Detailed Answer
1. Review Maryland’s Insurance Reporting Requirements
Maryland operates under a reparations (no-fault) system that requires you to submit proof of loss, including medical bills and records, to your insurer within 60 days of receiving treatment. See Md. Ins. Code Ann. § 19-504 for statutory details: https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=ins§ion=19-504.
2. Obtain Complete Medical Records
Use a HIPAA-compliant Authorization to Release Protected Health Information form. Request:
- Emergency room and hospital records
- Physician notes and diagnoses
- Physical therapy or chiropractic treatment notes
- Imaging reports (X-rays, MRIs)
- Prescription records and pharmacy receipts
3. Organize and Summarize Your Records
Create a cover sheet or index that includes:
- Date of service
- Provider name and address
- Type of treatment or service
- Billed amount and paid amount
This summary helps your insurer and, if needed, opposing counsel quickly locate relevant documents.
4. Make and Preserve Copies
Make clear, legible copies of every page. Retain originals in a secure location. Label each packet (for example, “January 12, 2023 – Orthopedic Consultation”).
5. Draft a Cover Letter
Include in your cover letter:
- Claim number, date of loss, and policyholder name
- List of enclosed documents
- Statement that this is a proof-of-loss submission under Md. Ins. Code § 19-504
6. Submit via Certified Mail or Other Trackable Method
Send the complete packet—cover letter, HIPAA authorization, index, and copies of records—to your insurer’s claims address. Use certified mail or a courier that provides delivery confirmation. This creates a paper trail of compliance with statutory deadlines.
7. Follow Up Promptly
Your insurer may request additional information or clarifications. Respond within 30 days to avoid a coverage dispute. Document all correspondence and phone calls with date, time, and name of the representative.
8. Preparing for a Potential Lawsuit
If negotiations stall, you may file suit in Maryland Circuit Court. Civil litigation uses Maryland Rules for discovery (see Md. Rule 2-402). You can supplement your initial submission with a subpoena duces tecum if necessary.
Helpful Hints
- Keep a digital backup of every document in PDF format.
- Use a spreadsheet or table to track treatment dates and costs.
- Confirm each provider has sent complete records before closing the authorization.
- Note any discrepancies between billed and allowed amounts.
- Keep a log of all expenses related to transportation and out-of-pocket costs.
- Consider retaining a medical billing advocate if records are complex or voluminous.