Colorado § 10-16-409 - Complaint system.

§ 10-16-409. Complaint system.

(1) (a) Every health maintenance organization shall establish and maintain a complaint system that has been approved by the commissioner to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning health-care services.

(b) Each health maintenance organization shall maintain written records relating to its complaint system in a form prescribed by the commissioner, for examination by the commissioner, which form must include:

(I) A description of the procedures of such complaint system;

(II) The total number of complaints handled through such complaint system and a compilation of causes underlying the complaints filed;

(III) The number, amount, and disposition of malpractice claims settled during the year by the health maintenance organization and any of the providers used by it which involve services covered by the health maintenance organization.

(2) The health maintenance organization shall maintain records of written complaints filed with it concerning other than health-care services and shall submit to the commissioner a summary report at such times and in such format as the commissioner may require. Such complaints involving other persons shall be referred to such persons with a copy to the commissioner.

(3) The commissioner may examine the complaint system required by subsection (1) of this section, subject to the limitations concerning medical records of individuals set forth in section 10-16-416 (3).

Source: L. 92: Entire article R&RE, p. 1701, § 1, effective July 1. L. 2017: (1)(a), IP(1)(b), and (3) amended, (SB 17-249), ch. 283, p. 1545, § 8, effective June 1.

Editor's note: This section is similar to former § 10-17-112 as it existed prior to 1992.

ANNOTATION

No conflict exists between the Health Care Availability Act and the Colorado Health Maintenance Organization Act. An agreement to arbitrate professional negligence claims obtained on behalf of persons or entities that unquestionably are health care providers must comply with the provisions of the Health Care Availability Act. Evans v. Colo. Permanente Medical Group, P.C., 902 P.2d 867 (Colo. App. 1995), aff'd, 926 P.2d 1218 (Colo. 1996).

If dispute resolution procedures include arbitration of professional negligence claims against health care providers who provide medical services, the patient must be notified of this fact in a manner consistent with the Health Care Availability Act requirements; this section does not conflict with requirements of that act. Evans v. Colo. Permanente Medical Group, P.C., 902 P.2d 867 (Colo. App. 1995), aff'd, 926 P.2d 1218 (Colo. 1996).