Sec. 843.254. APPEAL TO COMPLAINT APPEAL PANEL; DEADLINES. (a) A health maintenance organization shall provide an appeals process for a complainant who is not satisfied with the resolution of the complaint. The appeals process must include the right of the complainant to:
(1) appear in person before a complaint appeal panel at the site at which the enrollee normally receives health care services or at another site agreed to by the complainant; or
(2) address a written appeal to the complaint appeal panel.
(b) The health maintenance organization shall send an acknowledgment letter to the complainant not later than the fifth business day after the date the written request for appeal is received.
(c) The health maintenance organization shall complete the appeals process not later than the 30th calendar day after the date the written request for appeal is received.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
Structure Texas Statutes
Title 6 - Organization of Insurers and Related Entities
Subtitle C - Life, Health, and Accident Insurers and Related Entities
Chapter 843 - Health Maintenance Organizations
Subchapter G. Dispute Resolution
Section 843.251. Complaint System Required; Commissioner Rules and Examination
Section 843.252. Complaint Initiation and Initial Response; Deadlines for Response and Resolution
Section 843.253. Complaint Investigation and Resolution
Section 843.254. Appeal to Complaint Appeal Panel; Deadlines
Section 843.255. Composition of Complaint Appeal Panel
Section 843.256. Information Provided to Complainant Relating to Complaint Appeal Panel
Section 843.257. Rights of Complainant at Complaint Appeal Panel Meeting
Section 843.258. Appeal Involving Ongoing Emergency or Continued Hospitalization
Section 843.259. Notice of Decision on Appeal
Section 843.260. Record of Complaints
Section 843.261. Special Provisions for Appeals of Adverse Determinations