26-34-112. Complaint system.
(a) Each health maintenance organization shall establish and maintain a complaint system which has been approved by the commissioner, after consultation with the administrator, to provide reasonable procedures for the resolution of written complaints initiated by enrollees.
(b) Each health maintenance organization shall submit to the commissioner and the administrator, an annual report, in a form the commissioner prescribes, after consultation with the administrator, which shall include:
(i) A description of the procedures of the complaint system;
(ii) The total number of complaints handled through the complaint system and a compilation of causes underlying the complaints filed; and
(iii) The number, amount and disposition of malpractice claims made by an enrollee of the organization that were settled during the year by the health maintenance organization. All such information shall be held in confidence by the commissioner.
(c) The commissioner or the administrator may examine the complaint system at any time.
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