Section 58-17C-58 - Establishment of grievance system by managed care plan or utilizationreview organization. - South Dakota Statutes

58-17C-58. Establishment of grievance system by managed care plan or utilization review organization. Each health carrier shall establish and maintain a grievance system, approved by the director after consultation with the secretary of the Department of Health, which may include an impartial mediation provision, to provide reasonable procedures for the resolution of grievances initiated by any enrollee concerning the provision of health care services. Mediation may be made available to enrollees unless an enrollee elects to litigate a grievance prior to submission to mediation. No medical malpractice damage claim is subject to arbitration under §§ 58-17C-58 to 58-17C-63, inclusive. Each health carrier shall provide that if a grievance is filed which requires a review of services authorized to be provided by a practitioner or if a grievance is filed which requires a review of treatment which has been provided by a practitioner, the review shall include a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment.

Source: SL 2000, ch 243, § 22; SL 2001, ch 278, § 2; SL 2003, ch 250, § 25.