Texas Insurance Code 4201.204 – Complaint System
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(a) A utilization review agent shall establish and maintain a complaint system that provides reasonable procedures for the resolution of oral or written complaints initiated by enrollees, patients, or health care providers concerning the utilization review.
(b) The complaint procedure must include a requirement that the utilization review agent provide a written response to the complainant within 30 days.
Terms Used In Texas Insurance Code 4201.204
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Written: includes any representation of words, letters, symbols, or figures. See Texas Government Code 311.005
(c) Repealed by Acts 2015, 84th Leg., R.S., Ch. 42 , Sec. 3.01(7), eff. September 1, 2015.
(d) A utilization review agent shall maintain a record of each complaint until the third anniversary of the date the complainant filed the complaint.