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Texas Insurance Code - INS § 843.252. Complaint Initiation and Initial Response; Deadlines for Response and Resolution

Current as of January 01, 2024 | Updated by Findlaw Staff

(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.

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Cite this article: FindLaw.com - Texas Insurance Code - INS § 843.252. Complaint Initiation and Initial Response; Deadlines for Response and Resolution - last updated January 01, 2024 | https://codes.findlaw.com/tx/insurance-code/ins-sect-843-252/

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