1999 Minnesota Statutes

     62Q.70 Appeal of the complaint decision. 

    Subdivision 1.    Establishment.  (a) Each health plan 
 company shall establish an internal appeal process for reviewing 
 a health plan company's decision regarding a complaint filed in 
 accordance with section 62Q.69.  The appeal process must meet 
 the requirements of this section.  

    (b) The person or persons with authority to resolve or 
 recommend the resolution of the internal appeal must not be 
 solely the same person or persons who made the complaint 
 decision under section 62Q.69. 

    (c) The internal appeal process must permit the receipt of 
 testimony, correspondence, explanations, or other information 
 from the complainant, staff persons, administrators, providers, 
 or other persons as deemed necessary by the person or persons 
 investigating or presiding over the appeal. 

    Subd. 2.    Procedures for filing an appeal.  If a 
 complainant notifies the health plan company of the 
 complainant's desire to appeal the health plan company's 
 decision regarding the complaint through the internal appeal 
 process, the health plan company must provide the complainant 
 the option for the appeal to occur either in writing or by 
 hearing. 

    Subd. 3.    Notification of appeal decisions.  (a) If a 
 complainant appeals in writing, the health plan company must 
 give the complainant written notice of the appeal decision and 
 all key findings within 30 days of the health plan company's 
 receipt of the complainant's written notice of appeal.  If a 
 complainant appeals by hearing, the health plan company must 
 give the complainant written notice of the appeal decision and 
 all key findings within 45 days of the health plan company's 
 receipt of the complainant's written notice of appeal. 

    (b) If the appeal decision is partially or wholly adverse 
 to the complainant, the notice must advise the complainant of 
 the right to submit the appeal decision to the external review 
 process described in section 62Q.73 and the procedure for 
 initiating the external process. 

    (c) Upon the request of the complainant, the health plan 
 company must provide the complainant with a complete summary of 
 the appeal decision.  

    HIST: 1999 c 239 s 36 

*   NOTE:  This section, as added by Laws 1999, chapter 239, 
*section 36, 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.