4916 - Oversight and surveillance of the external appeal process.
§ 4916. Oversight and surveillance of the external appeal process. (a) The superintendent shall have the power to: (1) review the activities of the health care plans and external appeal agents pursuant to this title, including the extent to which such plans and agents adhere to the standards and time frames required pursuant to this title; (2) investigate complaints by insureds regarding requests for and processing of external appeals; and (3) conduct random audits of health care plans and external appeal agents to determine compliance with the provisions of this title. (b) Each health care plan and external appeal agent shall annually, in such form as the superintendent shall require, report the number of external appeals requested by insureds and the outcomes of any such external appeals. (c) The superintendent shall annually report, by plan and by agent, such information to the governor and the legislature, provided that no such information shall be included which would otherwise be deemed confidential information within the meaning of this chapter.