Tex. Ins. Code § 843.253

Current with legislation from the 2023 Regular and Special Sessions signed by the Governor as of November 21, 2023.
Section 843.253 - Complaint Investigation and Resolution
(a) A health maintenance organization shall investigate each complaint received in accordance with the health maintenance organization's policies and in compliance with this chapter.
(b) After a health maintenance organization has investigated a complaint, the health maintenance organization shall issue a response letter to the complainant within the time prescribed by Section 843.252(c) that:
(1) explains the health maintenance organization's resolution of the complaint;
(2) states the specific medical and contractual reasons for the resolution;
(3) states the specialization of any physician or other provider consulted; and
(4) contains a complete description of the process for appeal, including the deadlines for the appeals process and the deadlines for the final decision on the appeal.

Tex. Ins. Code § 843.253

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. 6/1/2003.