Tex.
Ins. Code Section 843.282
Submitting Complaints to Department
(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 (Coverage Required);(3)
Subchapter A (Applicability of Certain Definitions), Chapter 1452 (Physician and Provider Credentials);(4)
Subchapter B (Purpose), Chapter 1507 (Consumer Choice of Benefits Plans);(5)
Chapters 222 (Life, Health, and Accident Insurance Premium Tax), 251 (General Provisions), and 258 (Health Maintenance Organizations), as applicable to a health maintenance organization; or(6)
Chapter 1271 (Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges) or 1272 (Delegation of Certain Functions by Health Maintenance Organization).(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.
Source:
Section 843.282 — Submitting Complaints to Department, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.843.htm#843.282 (accessed Jun. 5, 2024).
