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Tex. Ins. Code § 843.254

APPEAL TO COMPLAINT APPEAL PANEL; DEADLINES

Known as the Texas Health Maintenance Organization Act

The act spans §§ 843–843 (146 sections).

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

(a) A health maintenance organization shall provide an appeals process for a complainant who is not satisfied with the resolution of the complaint. The appeals process must include the right of the complainant to:

(1) appear in person before a complaint appeal panel at the site at which the enrollee normally receives health care services or at another site agreed to by the complainant; or

(2) address a written appeal to the complaint appeal panel.

(b) The health maintenance organization shall send an acknowledgment letter to the complainant not later than the fifth business day after the date the written request for appeal is received.

(c) The health maintenance organization shall complete the appeals process not later than the 30th calendar day after the date the written request for appeal is received.

Official source: Texas Constitution and Statutes. Reproduced from public-domain Texas statutes; confirm against the official source for the current text. Not legal advice.