Sec. 843.253. COMPLAINT INVESTIGATION AND RESOLUTION. (a) A health maintenance organization shall investigate each complaint received in accordance with the health maintenance organization's policies and in compliance with this chapter. (b) After a health maintenance organization has investigated a complaint, the health maintenance organization shall issue a response letter to the complainant within the time prescribed by Section 843.252 (c) that: (1) explains the health maintenance organization's resolution of the complaint; (2) states the specific medical and contractual reasons for the resolution; (3) states the specialization of any physician or other provider consulted; and (4) contains a complete description of the process for appeal, including the deadlines for the appeals process and the deadlines for the final decision on the appeal.
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