2006 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.
History: 1999 c 239 s 36