§ 62D.11 — Complaint System
Plain-Language Summary
This section requires every HMO to set up and maintain a system for handling enrollee complaints. The Commissioner of Health can review complaints about service coverage disputes and order appropriate remedies. When an HMO denies coverage, it must give the enrollee a written explanation and information about complaint procedures.
62D.11 COMPLAINT SYSTEM.
§
Subdivision 1.Enrollee complaint system.
Every health maintenance organization shall establish and maintain a complaint system, as required under sections 62Q.68 to 62Q.72 to provide reasonable procedures for the resolution of written complaints initiated by or on behalf of enrollees concerning the provision of health care services. §
Subd. 1a.Service coverage.
Where a complaint involves a dispute about a health maintenance organization’s coverage of a service, the commissioner may review the complaint and any information and testimony necessary in order to make a determination and order the appropriate remedy pursuant to sections 62D.15 to 62D.17. §
Subd. 1b.
[Repealed, 1999 c 239 s 43 para (a)] §
Subd. 2.
[Repealed, 1999 c 239 s 43 para (a)] §
Subd. 3.Denial of coverage.
Within a reasonable time after receiving an enrollee’s written or oral communication to the health maintenance organization concerning a denial of coverage or inadequacy of services, the health maintenance organization shall provide the enrollee with a written statement of the reason for the denial of coverage, and a statement approved by the commissioner of health which explains the health maintenance organization complaint procedures, and in the case of Medicare enrollees, which also explains Medicare appeal procedures. §
Subd. 4.
[Repealed, 1997 c 205 s 40]
History:
1973 c 670 s 11; 1974 c 284 s 5; 1977 c 305 s 45; 1986 c 444; 1988 c 434 s 10; 1988 c 592 s 6,7; 1990 c 538 s 22-24; 1995 c 234 art 2 s 1; 1997 c 205 s 12-14; 1998 c 407 art 2 s 2; 1999 c 239 s 1
History: History: 1973 c 670 s 11; 1974 c 284 s 5; 1977 c 305 s 45; 1986 c 444; 1988 c 434 s 10; 1988 c 592 s 6,7; 1990 c 538 s 22-24; 1995 c 234 art 2 s 1; 1997 c 205 s 12-14; 1998 c 407 art 2 s 2; 1999 c 239 s 1