Texas Insurance Code 843.282 – Submitting Complaints to Department
(a) Any person, including a person who has attempted to resolve a complaint through a health maintenance organization’s complaint system process and is dissatisfied with the resolution, may submit a complaint to the department alleging a violation of:
(1) this chapter;
(2) § 1367.053;
(3) Subchapter A, Chapter 1452;
(4) Subchapter B, Chapter 1507;
(5) Chapters 222, 251, and 258, as applicable to a health maintenance organization; or
(6) Chapter 1271 or 1272.
(b) The commissioner shall complete an investigation of a complaint against a health maintenance organization to determine whether a violation has occurred not later than the 60th day after the date the department receives the complaint and all information necessary for the commissioner to make a determination.
Terms Used In Texas Insurance Code 843.282
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Person: includes corporation, organization, government or governmental subdivision or agency, business trust, estate, trust, partnership, association, and any other legal entity. See Texas Government Code 311.005
(c) The commissioner may extend the time necessary to complete an investigation if:
(1) additional information is needed;
(2) an on-site review is necessary;
(3) the health maintenance organization, the physician or provider, or the complainant does not provide all documentation necessary to complete the investigation; or
(4) other circumstances beyond the control of the department occur.