The Maryland Insurance Administration is committed to providing transparent, accessible, and meaningful information to consumers, policymakers, and other stakeholders. The
Appeals and Grievances Power BI Dashboard incorporates several interactive features designed to enhance data exploration and analysis. The hover-over functionality enables users to position their cursor over individual data points to view precise values, including the year and the number of adverse decisions or grievances associated with that point.
The dashboard also includes list slicers, which display the complete list of companies and services available to view. These slicers allow users to filter the dashboard to isolate and examine data pertaining to a specific company or service of interest.
Additionally, a multiselect feature permits users to select multiple companies and/or services. Depending on the specific dashboard, this feature will either aggregate the selected values into a cumulative sum or display each selected value independently, allowing direct comparison across companies and services.
Finally, zoom sliders are provided to support closer examination of the y-axis, particularly for services with smaller values that may otherwise be difficult to distinguish at the default scale.
Tab 1: Provides an overall view of adverse decisions by year and by insurer.
Tab 2: Provides an overall view of grievances by year and by insurer.
Tab 3: Provides an overview of adverse decisions by year and insurer, broken down by service
to compare trends over the years.
Tab 4: Provides an overview of grievances by year and insurer, broken down by service to compare trends over the years.
Tab 5: Provides an overview of the volume of adverse decisions by service and year, with each insurer displayed separately.
Tab 6: Provides an overview of the volume of grievances by service and year, with each insurer displayed separately.
Tab 7: Provides separate views of adverse decisions and grievances by year, with trends broken down by service and insurers displayed side by side for comparison.
Tab 8: Provides an overview of complaint outcomes by year and insurer, showing the distribution of complaint outcomes over time.
About Maryland’s Appeals and Grievance Law and Key Definitions
Maryland’s
Appeals and Grievance Law – enacted originally in 1998 and later expanded – gives consumers in state-regulated health plans the right to challenge health insurance denials for medical necessity, contractual coverage decisions, eligibility rejections, or coverage rescissions.
Adverse Decision: A determination by an insurer that a proposed or delivered health care service is not medically necessary, appropriate or efficient.
Grievance: When an insured person, the insured person’s representative, or the treating provider on behalf of the insured person files a protest with the insurer.
Complaint: If the carrier again determines the proposed or delivered health care service is not medically necessary, the insured person, the insured person’s representative, or the treating provider on behalf of the insured person may ask the Maryland Insurance Administration to review the carrier’s grievance decision by filing a complaint.
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Visit our website to learn more about Maryland's Appeals and Grievance Law.
