Sec. 843.259. NOTICE OF DECISION ON APPEAL. (a) A health maintenance organization shall include in a notice of the final decision on an appeal a statement of the specific medical determination, clinical basis, and contractual criteria used to reach the final decision.
(b) The notice must include the toll-free telephone number and address of the department.
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