MAUA is a new practice, MAUA  is trying to negotiate equitable contracts.

Aetna   New Contract Signed

Cigna is in negotiations and a contract is probable.

Care First  said they will not negotiate   Rep: Leigh Whitman-Priest   (410) 872-3832

      We  have accepted a partial contract with Care First/Blue Choice

      We will NOT participate with the BlueChoice HMO's unless you have out of plan coverage

      We will continue to participate with the other Dare First Plans

United Health Care/ MAMSI New Contract signed

Please call and tell your insurer that you want to stay with your doctor and they should make any necessary efforts to keep him in the panel.

A Traditional HMO   

  •         Members with traditional HMO benefits can see a participating physician or facility only when referred by their PCP. (need a referral). 

    Members may not see a non-participating physician even with a referral.   If a member wants to see a non-participating physician, the member needs to sign a strictly cash arrangement waiver. the physician’s office must collect all fees at the time of service. No claims may be filed with the carrier by either party. HMO carriers will not reimburse services rendered by a non-participating physician in an out-patient setting. 

•    According to the Maryland state law, if members are treated in a trauma or in-patient situation, the carrier must pay the non-participating physician fee. Under these circumstances, physicians must be aware that they may need to file an appeal (s) and therefore payments can be delayed. 

•    Members without out-of-network benefits can see a participating physician in an out-patient setting without a referral.  

    Members may not see a non-participating physician even with a referral.   If a member wants to see a non-participating physician, the member needs to sign a strictly cash arrangement waiver. the physician’s office must collect all fees at the time of service. No claims may be filed with the carrier by either party. HMO carriers will not reimburse services rendered by a non-participating physician in an out-patient setting. 

•    According to the Maryland state law, if members are treated in a trauma or in-patient situation, the carrier must pay the non-participating physician fee. Under these circumstances, physicians must be aware that they may need to file an appeal (s) and therefore payments can be delayed. 

•    Members with out-of-network benefits can see a non-participating physician in an out-patient setting without a referral. 

•    Members need to sign an out-of-network waiver, agreeing to pay balances unpaid by the carrier.

   •    Members may assign benefits to the physician. Depending on the carrier, assignment of benefits may not be recognized. Under these circumstances, the carrier may send the payment to the member, rather than the physician directly. In which case the patient must endorse the check to the physician and send it in.

   •    According to the Maryland state law, if members are treated in a trauma or in-patient situation, the carrier must pay the non-participating physician fee.

•    Members with indemnity plans can see any physician in an out-patient setting or in-patient setting.

   •    Members may assign benefits to the physician. Depending on the carrier, assignment of benefits may not be recognized. Under these circumstances, the carrier may send the payment to the member, rather than the physician directly. In which case the patient must endorse the check to the physician and send it in.

   •    Physicians offices are not required to have members sign a waiver to collect payments for services rendered.