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Texas Statutes (Last Updated: January 4, 2014) |
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INSURANCE CODE |
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Title 6. ORGANIZATION OF INSURERS AND RELATED ENTITIES |
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Subtitle C. LIFE, HEALTH, AND ACCIDENT INSURERS AND RELATED ENTITIES |
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Chapter 843. HEALTH MAINTENANCE ORGANIZATIONS |
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Subchapter G. DISPUTE RESOLUTION |
Sec. 843.252. COMPLAINT INITIATION AND INITIAL RESPONSE; DEADLINES FOR RESPONSE AND RESOLUTION
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(a) If a complainant notifies a health maintenance organization of a complaint, the health maintenance organization, not later than the fifth business day after the date of receiving the complaint, shall send to the complainant a letter acknowledging the date of receipt of the complaint.
(b) The letter required under Subsection (a) must:
(1) include a description of the health maintenance organization's complaint procedures and time frames; and
(2) if the complaint is made orally, be accompanied by a one-page complaint form that prominently and clearly states that the form must be returned to the health maintenance organization for prompt resolution of the complaint.
(c) A health maintenance organization shall acknowledge, investigate, and resolve a complaint not later than the 30th calendar day after the date the health maintenance organization receives the written complaint or one-page complaint form from the complainant.
(d) Subsections (a)-(c) do not apply to a complaint concerning an emergency or a denial of continued hospitalization. A health maintenance organization shall investigate and resolve a complaint concerning an emergency or a denial of continued hospitalization:
(1) in accordance with the medical or dental immediacy of the case; and
(2) not later than one business day after the health maintenance organization receives the complaint.