Effective 28 Aug 1997

376.1375. Registry of grievances maintained, procedures — definitions. — 1. A health carrier shall maintain a written register of all grievances in a manner consistent with the requirements for maintaining complaint records pursuant to section 354.445. The grievance register shall contain the total number, type, nature and result of all grievances and such other information as may be prescribed by the director. A health carrier shall furnish the director with any records regarding a grievance upon request.

2. All grievances shall be date stamped when received by the health carrier. The date shall be legible and easily identified.

3. Upon receipt of any inquiry from the department of commerce and insurance regarding a grievance, a health carrier shall mail to the department an adequate response to the inquiry within twenty days from the date the department mails the inquiry. An envelope's postmark shall determine the date of mailing. When the requested response is not produced by the health carrier within twenty days, this nonproduction shall be deemed a violation of law, unless the person can demonstrate that there is reasonable justification for that delay. As used in this section:

(1) "Inquiry", each and every question or request for information submitted in writing to a health carrier by the department concerning a grievance;

(2) "Adequate response", a written response answering each inquiry with reasonable specificity. A health carrier's acknowledgment of the department's inquiry is not an adequate response.

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(L. 1997 H.B. 335)