6.6.610    GRIEVANCE AND COMPLAINT PROCEDURE

(1) A medicare select issuer shall have and use procedures for hearing complaints and resolving written grievances from the subscribers. Such procedures shall be aimed at mutual agreement for settlement and may include arbitration procedures.

(2) The grievance procedure shall be described in the policies and certificates and in the outline of coverage.

(3) At the time the policy or certificate is issued, the issuer shall provide detailed information to the policyholder describing how a grievance may be registered with the issuer.

(4) Grievances shall be considered in a timely manner and shall be transmitted to appropriate decision-makers who have authority to fully investigate the issue and take corrective action.

(5) If a grievance is found to be valid, corrective action shall be taken promptly.

(6) All concerned parties shall be notified about the results of a grievance.

(7) The issuer shall report no later than each March 31 to the commissioner regarding its grievance procedure. The report shall be in a format prescribed by the commissioner and shall contain the number of grievances filed in the past year and a summary of the subject, nature and resolution of such grievances.

History: 33-22-904 and 33-22-905, MCA; IMP, 33-22-901 through 33-22-924, MCA; NEW, 1996 MAR p. 907, Eff. 4/5/96.