Texas Insurance Code 1271.054 – Information About Complaints and Appeals
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(a) An evidence of coverage must contain a clear and understandable description of the health maintenance organization’s methods for resolving enrollee complaints, including:
(1) the enrollee’s right to appeal denial of an adverse determination to an independent review organization; and
(2) the procedures for appealing to an independent review organization.
(b) A health maintenance organization may indicate a subsequent change to the methods for resolving enrollee complaints in a separate document issued to the enrollee.
Terms Used In Texas Insurance Code 1271.054
- 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.
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.