6 TIC §843.253(b)

August 8, 2021 3:36 am Published by

(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.

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