Sec. 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;
(3) Subchapter A, Chapter 1452;
(4) Subchapter B, Chapter 1507;
(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.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2E.047, eff. April 1, 2009.
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