Minnesota Statutes 62D.11 – Complaint System
Subdivision 1.Enrollee complaint system.
Every health maintenance organization shall establish and maintain a complaint system, as required under sections 62Q.68 to 62Q.72 to provide reasonable procedures for the resolution of written complaints initiated by or on behalf of enrollees concerning the provision of health care services.
Subd. 1a.Service coverage.
Terms Used In Minnesota Statutes 62D.11
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Testimony: Evidence presented orally by witnesses during trials or before grand juries.
Terms Used In Minnesota Statutes 62D.11
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Testimony: Evidence presented orally by witnesses during trials or before grand juries.
Where a complaint involves a dispute about a health maintenance organization’s coverage of a service, the commissioner may review the complaint and any information and testimony necessary in order to make a determination and order the appropriate remedy pursuant to sections 62D.15 to 62D.17.
Subd. 1b.
[Repealed, 1999 c 239 s 43 para (a)]
Subd. 2.
[Repealed, 1999 c 239 s 43 para (a)]
Subd. 3.Denial of coverage.
Within a reasonable time after receiving an enrollee’s written or oral communication to the health maintenance organization concerning a denial of coverage or inadequacy of services, the health maintenance organization shall provide the enrollee with a written statement of the reason for the denial of coverage, and a statement approved by the commissioner of health which explains the health maintenance organization complaint procedures, and in the case of Medicare enrollees, which also explains Medicare appeal procedures.
Subd. 4.
[Repealed, 1997 c 205 s 40]