1997 Minnesota Statutes

     62D.11 Complaint system. 

    Subdivision 1.    Enrollee complaint system.  Every 
 health maintenance organization shall establish and maintain a 
 complaint system, as required under section 62Q.105 to provide 
 reasonable procedures for the resolution of written complaints 
 initiated by or on behalf of enrollees concerning the provision 
 of health care services.  "Provision of health services" 
 includes, but is not limited to, questions of the scope of 
 coverage, quality of care, and administrative operations.  The 
 health maintenance organization must inform enrollees that they 
 may choose to use alternative dispute resolution to appeal a 
 health maintenance organization's internal appeal decision.  If 
 an enrollee chooses to use an alternative dispute resolution 
 process, the health maintenance organization must participate. 

    Subd. 1a.  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.    Expedited resolution of complaints about 
 medically urgent services.  In addition to any remedy 
 contained in subdivision 1a, when a complaint involves a dispute 
 about a health maintenance organization's coverage of a 
 medically urgent service, the commissioner may also order the 
 health maintenance organization to use an expedited system to 
 process the complaint. 

    Subd. 2.  The health maintenance organization shall 
 maintain a record of each written complaint filed with it for 
 five years and the commissioner of health shall have access to 
 the records. 

    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 Repealed, 1997 c 205 s 40 

    HIST: 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