§ 23-76-116 — Complaint system

(a) (1) Every health maintenance organization shall establish and maintain a complaint system that has been approved by the Insurance Commissioner to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning healthcare services. (2) Each health maintenance organization shall submit to the commissioner an annual report in a form prescribed by the commissioner that shall include: (A) A description of the procedures of the complaint system; (B) The total number of complaints handled through the complaint system and a compilation of causes underlying the complaints filed; and (C) The number, amount, and disposition of malpractice claims settled during the year by the health maintenance organization. (b) (1) The health maintenance organization shall maintain records of written complaints filed with it concerning issues and persons other than healthcare services and shall submit to the commissioner a summary report at such times and in such format as the commissioner may require. (2) Complaints involving other persons shall be referred to the persons with a copy to the commissioner. (c) The commissioner may examine the complaint system, subject to the limitation concerning medical records of individuals set forth in § 23-76-122(c) .

Legislative History

Amended by Act 2013, No. 1433,§ 6, eff. 8/16/2013. Acts 1975, No. 454, § 12; A.S.A. 1947, § 66-5212; Acts 2001, No. 1605, § 7.