Missouri § 376.1385 - Second-level review procedures.
Full text of Missouri Revised Statutes of Missouri § 376.1385 — Second-level review procedures., with citation guidance and answers to common questions.
§ 376.1385. Second-level review procedures.
1. Upon receipt of a request for second-level review, a health carrier shall submit the grievance to a grievance advisory panel consisting of:
(1) Other enrollees; and
(2) Representatives of the health carrier that were not involved in the circumstances giving rise to the grievance or in any subsequent investigation or determination of the grievance.
2. Where the grievance involves an adverse determination, and the grievance advisory panel makes a preliminary decision that the determination should be upheld, the health* carrier shall submit the grievance for review to two independent clinical peers in the same or similar specialty as would typically manage the case being reviewed who were not involved in the circumstances giving rise to the grievance or in any subsequent investigation or determination of the grievance. In the event that both independent reviews concur with the grievance advisory panel's preliminary decision, the panel's decision shall stand. In the event that both independent reviewers disagree with the grievance advisory panel's preliminary decision, the initial** adverse determination shall be overturned. In the event that one of the two independent reviewers disagrees with the grievance advisory panel's preliminary decision, the panel shall reconvene and make a final decision in its discretion.
3. Review by the grievance advisory panel shall follow the same time frames as a first level review, except as provided for in section 376.1389 if applicable. Any decision of the grievance advisory panel shall include notice of the enrollee's or the health carrier's or plan sponsor's rights to file an appeal with the director's office of the grievance advisory panel's decision. The notice shall contain the toll-free telephone number and address of the director's office.
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(L. 1997 H.B. 335, A.L. 2019 S.B. 514)
*Word "heath" appears in original rolls.
**Word "intitial" appears in original rolls.
---- end of effective 28 Aug 2019 ----
Frequently Asked Questions About Missouri § 376.1385
What does Revised Statutes of Missouri § 376.1385 cover?
Section 376.1385 ("Second-level review procedures.") is part of the Revised Statutes of Missouri, the codified statutory law of Missouri. It sets out the legal rule or procedure described in the text above. Statutes are amended regularly, so always verify against the official source.
How do I cite Missouri § 376.1385?
A common citation format is "Revised Statutes of Missouri § 376.1385" (Missouri). Legal writing may require the code abbreviation, section number, and year or edition. Match the style required by your court, professor, or publisher.
Is this the official text of Missouri law?
No. This page is for research and education and may not include the most recent amendments. For official current law, check the Missouri official source linked on this page or consult a licensed Missouri attorney.
How does Missouri § 376.1385 apply to my situation?
Statutes are interpreted in context, and application depends on your specific facts. Only a licensed attorney in Missouri can advise on how this section applies to you. Contact your state or local bar association for a referral.
Sources & Verification
Not legal advice. Verify against the official source and consult a licensed attorney in Missouri.