§ 843.252 — COMPLAINT INITIATION AND INITIAL RESPONSE; DEADLINES FOR RESPONSE AND RESOLUTION.

Texas § 843.252

• Jurisdiction: Texas
• Code IN: Insurance Code

Text

Sec. 843.252. COMPLAINT INITIATION AND INITIAL RESPONSE; DEADLINES FOR RESPONSE AND RESOLUTION. (a) If a complainant notifies a health maintenance organization of a complaint, the health maintenance organization, not later than the fifth business day after the date of receiving the complaint, shall send to the complainant a letter acknowledging the date of receipt of the complaint.
(b) The letter required under Subsection (a) must:
(1) include a description of the health maintenance organization's complaint procedures and time frames; and
(2) if the complaint is made orally, be accompanied by a one-page complaint form that prominently and clearly states that the form must be returned to the health maintenance organization for prompt resolution of the complaint.
(c) A health maintenance organization shall acknowledge, investigate, and resolve a complaint not later than the 30th calendar day after the date the health maintenance organization receives the written complaint or one-page complaint form from the complainant.
(d) Subsections (a)-(c) do not apply to a complaint concerning an emergency or a denial of continued hospitalization. A health maintenance organization shall investigate and resolve a complaint concerning an emergency or a denial of continued hospitalization:
(1) in accordance with the medical or dental immediacy of the case; and
(2) not later than one business day after the health maintenance organization receives the complaint.

Legislative History

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.