Section 4916. Oversight and surveillance of the external appeal process  


Latest version.
  • 1.
      The commissioner shall have the power to:
        (a) review the activities of the health care plans and external appeal
      agents pursuant to this title, including the extent to which such  plans
      and  agents adhere to the standards and time frames required pursuant to
      this title;
        (b) investigate complaints by enrollees  regarding  requests  for  and
      processing of external appeals; and
        (c)  conduct  random  audits  of health care plans and external appeal
      agents to determine compliance with the provisions of this title.
        2. Each health care plan and external appeal agent shall annually,  in
      such  form  as  the  commissioner  shall  require,  report the number of
      external appeals requested by enrollees and the  outcomes  of  any  such
      external appeals.
        3.  The  commissioner  shall  annually report, by plan and agent, such
      information to the governor and the legislature, provided that  no  such
      information   shall   be   included  which  would  otherwise  be  deemed
      confidential information within the meaning of this chapter.