Sec. 843.252.  COMPLAINT INITIATION AND INITIAL RESPONSE;  DEADLINES FOR RESPONSE AND RESOLUTION.  (a)  If a complainant notifies a health maintenance organization of a complaint, the health maintenance organization, not later than the fifth business day after the date of receiving the complaint, shall send to the complainant a letter acknowledging the date of receipt of the complaint.
(b)  The letter required under Subsection (a) must:
(1)  include a description of the health maintenance organization's complaint procedures and time frames;  and
(2)  if the complaint is made orally, be accompanied by a one-page complaint form that prominently and clearly states that the form must be returned to the health maintenance organization for prompt resolution of the complaint.
(c)  A health maintenance organization shall acknowledge, investigate, and resolve a complaint not later than the 30th calendar day after the date the health maintenance organization receives the written complaint or one-page complaint form from the complainant.
(d)  Subsections (a)-(c) do not apply to a complaint concerning an emergency or a denial of continued hospitalization.  A health maintenance organization shall investigate and resolve a complaint concerning an emergency or a denial of continued hospitalization:
(1)  in accordance with the medical or dental immediacy of the case;  and
(2)  not later than one business day after the health maintenance organization receives the complaint.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.