§ 23-76-116 - Complaint system. - Arkansas Statutes

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Statutes > Arkansas > Title-23 > Subtitle-3 > Chapter-76 > 23-76-116

23-76-116. Complaint system.

(a) (1) Every health maintenance organization shall establish and maintain a complaint system that has been approved by the Insurance Commissioner after consultation with the Director of the Department of Health to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning health care services.

(2) Each health maintenance organization shall submit to the commissioner and the director an annual report in a form prescribed by the commissioner, after consultation with the director, that shall include:

(A) A description of the procedures of the complaint system;

(B) The total number of complaints handled through the complaint system and a compilation of causes underlying the complaints filed; and

(C) The number, amount, and disposition of malpractice claims settled during the year by the health maintenance organization.

(b) The health maintenance organization shall maintain records of written complaints filed with it concerning other than health care services and shall submit to the commissioner a summary report at such times and in such format as the commissioner may require. Complaints involving other persons shall be referred to the persons with a copy to the commissioner.

(c) The commissioner or the director may examine the complaint system, subject to the limitation concerning medical records of individuals set forth in 23-76-122(c).

State Codes and Statutes

Statutes > Arkansas > Title-23 > Subtitle-3 > Chapter-76 > 23-76-116

23-76-116. Complaint system.

(a) (1) Every health maintenance organization shall establish and maintain a complaint system that has been approved by the Insurance Commissioner after consultation with the Director of the Department of Health to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning health care services.

(2) Each health maintenance organization shall submit to the commissioner and the director an annual report in a form prescribed by the commissioner, after consultation with the director, that shall include:

(A) A description of the procedures of the complaint system;

(B) The total number of complaints handled through the complaint system and a compilation of causes underlying the complaints filed; and

(C) The number, amount, and disposition of malpractice claims settled during the year by the health maintenance organization.

(b) The health maintenance organization shall maintain records of written complaints filed with it concerning other than health care services and shall submit to the commissioner a summary report at such times and in such format as the commissioner may require. Complaints involving other persons shall be referred to the persons with a copy to the commissioner.

(c) The commissioner or the director may examine the complaint system, subject to the limitation concerning medical records of individuals set forth in 23-76-122(c).

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State Codes and Statutes

Statutes > Arkansas > Title-23 > Subtitle-3 > Chapter-76 > 23-76-116

23-76-116. Complaint system.

(a) (1) Every health maintenance organization shall establish and maintain a complaint system that has been approved by the Insurance Commissioner after consultation with the Director of the Department of Health to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning health care services.

(2) Each health maintenance organization shall submit to the commissioner and the director an annual report in a form prescribed by the commissioner, after consultation with the director, that shall include:

(A) A description of the procedures of the complaint system;

(B) The total number of complaints handled through the complaint system and a compilation of causes underlying the complaints filed; and

(C) The number, amount, and disposition of malpractice claims settled during the year by the health maintenance organization.

(b) The health maintenance organization shall maintain records of written complaints filed with it concerning other than health care services and shall submit to the commissioner a summary report at such times and in such format as the commissioner may require. Complaints involving other persons shall be referred to the persons with a copy to the commissioner.

(c) The commissioner or the director may examine the complaint system, subject to the limitation concerning medical records of individuals set forth in 23-76-122(c).