Insurance Code § 843.253

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