Information About Complaints and Appeals

Sec. 1271.054. INFORMATION ABOUT COMPLAINTS AND APPEALS. (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. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.