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The DC Code: § 44-301.04 Grievance process.

Index44 Charitable and Curative Institutions. (Refs & Annos)
a
A member or member representative may appeal any grievance decision resulting in a denial, termination, or other limitation of covered health care services in accordance with the provisions of this section.
b
At the time a grievance decision is determined, an insurer shall provide to the affected member or member representative a written description of the procedures for filing grievances.
c
The grievance process shall consist of 3 separate grievance levels:   informal internal review by the insurer;  formal review by the insurer;  and formal external review by an independent review organization.
d
Nothing in the health benefits plan shall prohibit a member or member representative from discussing or exercising the right to appeal pursuant to this section.

Historical and Statutory

Prior Codifications 1981 Ed., § 32-571.4. Legislative History of Laws For legislative history of D.C. Law 12-274, see Historical and Statutory Notes following § 44-301.01. DC CODE § 44-301.04 Current through December 11, 2012

Credits

(Apr. 27, 1999, D.C. Law 12-274, § 104, 46 DCR 1294.)