Colorado § 10-16-409 Complaint system

Colorado Statutes

§ 10-16-409 — Complaint system

Colorado·Title 10 Insurance·Art. Health-care Coverage

(1)(a) Every health maintenance organization shall establish and maintain a complaint system that has been approved by the commissioner to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning health-care services.

(b)Each health maintenance organization shall maintain written records relating to its complaint system in a form prescribed by the commissioner, for examination by the commissioner, which form must include:

(I)A description of the procedures of such complaint system;

(II)The total number of complaints handled through such complaint system and a compilation of causes underlying the complaints filed;

(III)The number, amount, and disposition of malpractice claims settled during the year by the health maintenance or

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(1) (a) Every health maintenance organization
shall establish and maintain a complaint system that has been approved by the
commissioner to provide reasonable procedures for the resolution of written
complaints initiated by enrollees concerning health-care services.

(b) Each health maintenance organization shall maintain written records
relating to its complaint system in a form prescribed by the commissioner, for
examination by the commissioner, which form must include:

(I) A description of the procedures of such complaint system;

(II) The total number of complaints handled through such complaint system
and a compilation of causes underlying the complaints filed;

(III) The number, amount, and disposition of malpractice claims settled
during the year by the health maintenance organization and any of the providers
used by it which involve services covered by the health maintenance organization.

(2) The health maintenance organization shall maintain records of written
complaints filed with it concerning other than health-care services and shall submit
to the commissioner a summary report at such times and in such format as the
commissioner may require. Such complaints involving other persons shall be
referred to such persons with a copy to the commissioner.

(3) The commissioner may examine the complaint system required by
subsection (1) of this section, subject to the limitations concerning medical records
of individuals set forth in section 10-16-416 (3).

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Legislative History

Source: L. 92: Entire article R&RE, p. 1701, � 1, effective July 1. L. 2017: (1)(a), IP(1)(b), and (3) amended, (SB 17-249), ch. 283, p. 1545, � 8, effective June 1.