Okla. Admin. Code § 365:40-5-100

Current through Vol. 42, No. 8, January 2, 2025

Section 365:40-5-100 - Request for assistance

(a) The Department shall expeditiously advise an HMO of each inquiry the Department receives regarding that HMO. Such inquiries need not be handled through the HMO's written grievance system.

(b) The Department shall provide a form that an enrollee may use to request assistance of the Department. The Department shall review such requests and consider whether or not the request for assistance raises issues of compliance with the HMO Act or the rules. If the Department has reason to believe that a violation exists, then the matter shall be considered by the Department and a determination shall be made by the Department as to the appropriate action to be taken.

(c) The Department shall not refer an inquiry or complaint to an HMO prior to investigating the matter if the Department has reason to believe that referring the inquiry or complaint may compromise the Department's ability to enforce the HMO Act or this Chapter.

Okla. Admin. Code § 365:40-5-100

Added at 21 Ok Reg 77, eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff 7-14-04