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Texas Insurance Code - INS § 843.282. Submitting Complaints to Department

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

(a) Any person, including a person who has attempted to resolve a complaint through a health maintenance organization's complaint system process and is dissatisfied with the resolution, may submit a complaint to the department alleging a violation of:

(1) this chapter;

(2) Section 1367.053;

(3) Subchapter A, Chapter 1452;  1

(4) Subchapter B, Chapter 1507;  2

(5) Chapters 222, 251, and 258, as applicable to a health maintenance organization; or

(6) Chapter 1271 or 1272.

(b) The commissioner shall complete an investigation of a complaint against a health maintenance organization to determine whether a violation has occurred not later than the 60th day after the date the department receives the complaint and all information necessary for the commissioner to make a determination.

(c) The commissioner may extend the time necessary to complete an investigation if:

(1) additional information is needed;

(2) an on-site review is necessary;

(3) the health maintenance organization, the physician or provider, or the complainant does not provide all documentation necessary to complete the investigation; or

(4) other circumstances beyond the control of the department occur.

1 V.T.C.A., Insurance Code § 1452.001 et seq.
2 V.T.C.A., Insurance Code § 1507.051 et seq.
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Cite this article: FindLaw.com - Texas Insurance Code - INS § 843.282. Submitting Complaints to Department - last updated January 01, 2024 | https://codes.findlaw.com/tx/insurance-code/ins-sect-843-282/

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