Okla. Admin. Code § 365:40-5-44

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

Section 365:40-5-44 - Internal grievance system

A grievance system shall be established and maintained by an HMO to provide reasonable procedures for the prompt and effective resolution of written grievances pursuant to the HMO Act.

(1) An HMO shall provide grievance forms to be given to enrollees who wish to register written grievances. Such forms shall include the address and telephone number to which grievances must be directed and shall also specify required time limits imposed by the HMO.

(2) The grievance system shall provide for written acknowledgement of any grievance within seven (7) days from the date the grievance is registered with the HMO. Each grievance shall be resolved or finally determined within one hundred twenty (120) days after the grievance is registered. This period may be extended in the event of a delay in obtaining the documents or records from a non-contracting provider necessary for the resolution of the grievance, or by the mutual written agreement of the HMO and the enrollee.

(3) An enrollee or any other person may seek the assistance of the Insurance Commissioner at any time whether or not a written grievance is submitted to an HMO by an enrollee.

Okla. Admin. Code § 365:40-5-44

Added at 21 Ok Reg 77, eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff 7-14-04; Amended at 23 Ok Reg 2758, eff 7-14-06