{"data":{"id":"us-tx/tex.-insurance-code-843.252","jurisdiction":"us-tx","citation":"Tex. Insurance Code § 843.252","heading":"COMPLAINT INITIATION AND INITIAL RESPONSE; DEADLINES FOR RESPONSE AND RESOLUTION.","body":"(a) If a complainant notifies a health maintenance organization of a complaint, the health maintenance organization, not later than the fifth business day after the date of receiving the complaint, shall send to the complainant a letter acknowledging the date of receipt of the complaint.\n(b) The letter required under Subsection (a) must:\n(1) include a description of the health maintenance organization's complaint procedures and time frames; and\n(2) if the complaint is made orally, be accompanied by a one-page complaint form that prominently and clearly states that the form must be returned to the health maintenance organization for prompt resolution of the complaint.\n(c) A health maintenance organization shall acknowledge, investigate, and resolve a complaint not later than the 30th calendar day after the date the health maintenance organization receives the written complaint or one-page complaint form from the complainant.\n(d) Subsections (a)-(c) do not apply to a complaint concerning an emergency or a denial of continued hospitalization. A health maintenance organization shall investigate and resolve a complaint concerning an emergency or a denial of continued hospitalization:\n(1) in accordance with the medical or dental immediacy of the case; and\n(2) not later than one business day after the health maintenance organization receives the complaint.\nAdded by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.","path":["INSURANCE CODE","TITLE 6. ORGANIZATION OF INSURERS AND RELATED ENTITIES","SUBTITLE C. LIFE, HEALTH, AND ACCIDENT INSURERS AND RELATED ENTITIES","CHAPTER 843. HEALTH MAINTENANCE ORGANIZATIONS","SUBCHAPTER G. DISPUTE RESOLUTION"],"source_url":"https://statutes.capitol.texas.gov/Docs/IN/htm/IN.843.htm#843.252","current_through":"89th 2nd Called Legislative Session, 2025","vintage":"","retrieved_at":"2026-08-27T01:47:21Z","sha256":"09c8a775022b7b35c1d5767c7c242408fc2ea77db72fa33592da935f82aa3160","source_id":"us-tx","stale":false,"prev":"us-tx/tex.-insurance-code-843.251","next":"us-tx/tex.-insurance-code-843.253"},"notice":"GroundRules: Original legal text. Not legal advice."}