MAMSI must repay claims, ruling says Decision not final until attorney general gives opinion, hearing is held


The state's insurance commissioner has ruled that Mid AtlanticMedical Services Inc. (MAMSI) of Rockville must repay claims it had improperly denied retroactively.

At issue is a law, effective last Oct. 1, that generally prohibits insurers from recovering money from doctors more than six months after a claim has been paid. The question was whether the effective date applied to claims paid six months before Oct. 1.

The ruling, issued Friday by Insurance Commissioner Steven B. Larsen, will not take final effect until the attorney general issues an opinion on the question and Larsen conducts a hearing at which MAMSI can contest his decision.

Elizabeth Sammis, a senior director of MAMSI, said her company was acting on legal advice that the law applied only to claims first paid after Oct. 1. But doctors argued -- and the insurance commissioner agreed -- that beginning Oct. 1, MAMSI could not recover money on a claim that was more than six months old -- that is, on claims paid before April 1, 1997.

"This was classic MAMSI," said T. Michael Preston, executive director of the Medical and Chirurgical Faculty of Maryland, the state medical society.

He said MAMSI had proceeded to deny claims despite a bulletin from the insurance commissioner and an advisory opinion from an assistant attorney general.

Larsen's ruling followed about 75 complaints from doctors.

Preston said the medical society had coordinated most of those, and was continuing to provide physicians with "template letters" to contest other claim denials.

Both Preston and Sammis said they were unsure of the dollar amount of the claims in dispute, although Preston said he thought it was "substantial."

Larsen could not be reached for comment.

Pub Date: 5/05/98

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