376.1389. Expedited grievance review procedure. - Missouri Statutes

Expedited grievance review procedure.

376.1389. 1. A health carrier shall establish written procedures forthe expedited review of a grievance involving a situation where the time frameof the standard grievance procedures set forth in sections 376.1382 and376.1385 would seriously jeopardize the life or health of an enrollee or wouldjeopardize the enrollee's ability to regain maximum function. A request foran expedited review may be submitted orally or in writing. However, forpurposes of the grievance register requirements in section 376.1375, therequest shall not be considered a grievance unless the request is submitted inwriting. Expedited review procedures shall be available to an enrollee, therepresentative of an enrollee and to the provider acting on behalf of anenrollee.

2. A health carrier shall notify an enrollee orally within seventy-twohours after receiving a request for an expedited review of the carrier'sdetermination, and shall provide written confirmation of its decision coveringan expedited review within three working days of providing notification of thedetermination. The provisions of sections 376.1350 to 376.1390 are notapplicable to health indemnity plans without a managed care component asdefined in 376.1350.

(L. 1997 H.B. 335)