376.1375. Registry of grievances maintained, procedures--definitions.
Registry of grievances maintained, procedures--definitions.
376.1375. 1. A health carrier shall maintain a written register of allgrievances in a manner consistent with the requirements for maintainingcomplaint records pursuant to section 354.445, RSMo. The grievance registershall contain the total number, type, nature and result of all grievances andsuch other information as may be prescribed by the director. A health carriershall furnish the director with any records regarding a grievance uponrequest.
2. All grievances shall be date stamped when received by the healthcarrier. The date shall be legible and easily identified.
3. Upon receipt of any inquiry from the department of insurance,financial institutions and professional registration regarding a grievance, ahealth carrier shall mail to the department an adequate response to theinquiry within twenty days from the date the department mails the inquiry. Anenvelope's postmark shall determine the date of mailing. When the requestedresponse is not produced by the health carrier within twenty days, thisnonproduction shall be deemed a violation of law, unless the person candemonstrate that there is reasonable justification for that delay. As used inthis section:
(1) "Inquiry", each and every question or request for informationsubmitted in writing to a health carrier by the department concerning agrievance;
(2) "Adequate response", a written response answering each inquiry withreasonable specificity. A health carrier's acknowledgment of the department'sinquiry is not an adequate response.
(L. 1997 H.B. 335)