Question 13011 of 324 · Texas Life, Accident and Health Agent Exam
In a Texas HMO, an enrollee has a complaint about a denied service. The HMO must
Exactly one answer is correct.
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Correct answer to question 13011
- A: maintain a complaint system and respond to the enrollee within the time required by law
Explanation
An HMO must implement and maintain a complaint system with a process for notice and appeal. It must acknowledge a complaint within five business days and investigate and resolve a written complaint within 30 calendar days.
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