24-A §4211. Complaint system
Title 24-A: MAINE INSURANCE CODE
Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS
§4211. Complaint system
1. Every health maintenance organization shall establish and maintain a complaint system which has been approved by the superintendent, after consultation with the Commissioner of Health and Human Services, to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning health care services and general operating procedures.
[ 1975, c. 503, (NEW); 2003, c. 689, Pt. B, §7 (REV) .]
2. Each health maintenance organization shall submit to the superintendent and the Commissioner of Health and Human Services an annual report in a form prescribed by the superintendent after consultation with the Commissioner of Health and Human Services that includes:
A. A description of the procedures of such complaint system; [1975, c. 503, (NEW).]
B. The total number and disposition of complaints handled through the complaint system and a compilation of causes underlying the complaints filed. Complaints concerning access to chiropractic providers and the results of those complaints must be separately identified; and [1993, c. 669, §4 (AMD).]
C. The number, amount and disposition of malpractice claims settled during the year by the health maintenance organization. [1975, c. 503, (NEW).]
[ RR 2003, c. 2, §87 (COR) .]
3. The health maintenance organization shall maintain records of written complaints filed with it concerning other than health care services and shall submit to the superintendent a summary report at such times and in such format as the superintendent may require. Such complaints involving other persons shall be referred to such persons with a copy to the superintendent.
[ 1975, c. 503, (NEW) .]
4. The superintendent and the Commissioner of Health and Human Services may examine such complaint system.
[ 1975, c. 503, (NEW); 2003, c. 689, Pt. B, §7 (REV) .]
SECTION HISTORY
1975, c. 293, §4 (AMD). 1975, c. 503, (NEW). 1993, c. 669, §4 (AMD). RR 2003, c. 2, §87 (COR). 2003, c. 689, §B7 (REV).