Sec. 4. (a) A health maintenance organization shall provide, at the request of the enrollee, subscriber, or legal representative of the enrollee or subscriber, and upon contract issuance, at each contract renewal, and with any notice of denial of a claim, timely, adequate, and appropriate notice to each enrollee, subscriber, or legal representative, of:
(1) the grievance procedure under this chapter and IC 27-13-10.1;
(2) information on how to file:
(A) a grievance under this chapter; and
(B) a request for an external grievance review under IC 27-13-10.1; and
(3) the address for the Internet web site established by the department under IC 27-1-3-33.
(b) A health maintenance organization shall prominently display on all notices to enrollees and subscribers the telephone number and address at which a grievance may be filed.
(c) A written description of the enrollee's or subscriber's right to file a grievance must be posted by the provider in a conspicuous public location in each facility that offers services on behalf of a health maintenance organization.
As added by P.L.191-1997, SEC.6. Amended by P.L.133-1999, SEC.5; P.L.18-2016, SEC.5.
Structure Indiana Code
Article 13. Health Maintenance Organizations
Chapter 10. Grievance Procedures
27-13-10-1. Establishment of Procedures
27-13-10-2. Examination by Commissioner
27-13-10-3. Records of Grievances
27-13-10-4. Notice of Grievance Related Information
27-13-10-5. Filing; Oral or Written Grievance; Telephone Number; Date
27-13-10-6. Filing; Procedures; Representative
27-13-10-7. Resolution of Grievances
27-13-10-8. Appeals of Grievance Decisions; Filing of Report for Violation
27-13-10-11. Action Against Provider Representing Enrollee or Subscriber