SECTION 13.491. Complaint Systems

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(a) Each HCC must implement and maintain a complaint system that complies with Insurance Code §848.107 and this division that provides reasonable procedures for resolving an oral or written complaint initiated by a complainant concerning the HCC or health care services arranged by, or offered through, the HCC.
(b) For purposes of this subchapter, a complaint is any oral or written expression of dissatisfaction by a complainant to an HCC regarding any aspect of the HCC's operation.
(c) The HCC's complaint system must address a complaint initiated:
(1) by or on behalf of a patient who sought or received health care services by a participant; or
(2) by a participant.
(d) The complaint system for complaints initiated by or on behalf of patients must include a process for the notice and appeal of a complaint.
(e) The commissioner has discretion to examine a complaint system for compliance with Insurance Code §848.107 and this subchapter and will require the HCC to make corrections that the commissioner considers necessary.

Source Note: The provisions of this §13.491 adopted to be effective March 31, 2013, 38 TexReg 2100

                    
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