2006 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    Subd. 1b.[Repealed, 1999 c 239 s 43 para (a)]
    Subd. 2.[Repealed, 1999 c 239 s 43 para (a)]
    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    Subd. 4.[Repealed, 1997 c 205 s 40]
History: 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