Texas Insurance Code 1272.063 – Enrollee Complaints
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(a) A delegation agreement required by Section 1272.052 must provide that:
(1) if the delegated entity receives a complaint that does not involve emergency care, the entity shall report the complaint to the health maintenance organization not later than the second business day after the date the entity receives the complaint; and
(2) if the delegated entity receives a complaint involving emergency care, the entity shall immediately forward the complaint to the health maintenance organization.
(b) Subsection (a) does not prohibit a delegated entity from attempting to resolve a complaint.
Terms Used In Texas Insurance Code 1272.063
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.