• Current through October 23, 2012

(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.

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


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.