1999 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 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.    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.    Records.  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 Repealed, 1997 c 205 s 40 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; 1998 c 407 art 2 s 2; 1999 
 c 239 s 1 

*   NOTE:  The amendment to subdivision 1 by Laws 1999, chapter 
*239, section 1, is effective April 1, 2000, and applies to 
*contracts issued or renewed on or after that date.  Upon 
*request, the commissioner of health or commerce shall grant an 
*extension of up to three months to any health plan company or 
*utilization review organization that is unable to comply with 
*Laws 1999, chapter 239, sections 1, 3 to 42, and 43, paragraphs 
*(a) and (c) by April 1, 2000, due to circumstances beyond the 
*control of the health plan company or utilization review 
*organization.  Laws 1999, chapter 239, section 44. 

*   NOTE:  Subdivisions 1b and 2 are repealed by Laws 1999, 
*chapter 239, section 43, paragraph (a), effective April 1, 2000, 
*and apply to contracts issued or renewed on or after that date.  
*Upon request, the commissioner of health or commerce shall grant 
*an extension of up to three months to any health plan company or 
*utilization review organization that is unable to comply with 
*Laws 1999, chapter 239, sections 1, 3 to 42, and 43, paragraphs 
*(a) and (c) by April 1, 2000, due to circumstances beyond the 
*control of the health plan company or utilization review 
*organization.  Laws 1999, chapter 239, section 44.