# COMAR Title 31 — Maryland Insurance Administration

## Subtitle 10 — Health Insurance — General

### Chapter 18 — Denials of Coverage Based on Medical Necessity

#### Regulation .05 Procedures for Emergency Cases.

*COMAR 31.10.18.05*

A. An expedited review of an adverse decision in accordance with this regulation is required if the:

  (1) Adverse decision is rendered for health care services that are proposed but have not been delivered; and

  (2) Services are necessary to treat a condition or illness that, without immediate medical attention, would:

    (a) Seriously jeopardize the life or health of the member of the member’s ability to regain maximum functions;

    (b) Cause the member to be in danger to self or others; or

    (c) Cause the member to continue using intoxicating substances in an imminently dangerous manner.

B. The content of any written notice by a carrier of an adverse decision or grievance decision under this regulation shall comply with Regulation .04 of this chapter and Insurance Article, §15-10A-02(f) and(i), Annotated Code of Maryland.