Subd. 1. Establishment.

1. (a) Each health plan company shall establish an internal appeal process for reviewing a health plan company's decision regarding a complaint filed in accordance with section 62Q.69. The appeal process must meet the requirements of this section.
2. (b) The person or persons with authority to resolve or recommend the resolution of the internal appeal must not be solely the same person or persons who made the complaint decision under section 62Q.69.
3. (c) The internal appeal process must permit the receipt of testimony, correspondence, explanations, or other information from the complainant, staff persons, administrators, providers, or other persons as deemed necessary by the person or persons investigating or presiding over the appeal.

Subd. 2. Procedures for filing an appeal.

If a complainant notifies the health plan company of the complainant's desire to appeal the health plan company's decision regarding the complaint through the internal appeal process, the health plan company must provide the complainant the option for the appeal to occur either in writing or by hearing.

Subd. 3. Notification of appeal decisions.

1. (a) If a complainant appeals in writing, the health plan company must give the complainant written notice of the appeal decision and all key findings within 30 days of the health plan company's receipt of the complainant's written notice of appeal. If a complainant appeals by hearing, the health plan company must give the complainant written notice of the appeal decision and all key findings within 45 days of the health plan company's receipt of the complainant's written notice of appeal.
2. (b) If the appeal decision is partially or wholly adverse to the complainant, the notice must advise the complainant of the right to submit the appeal decision to the external review process described in section 62Q.73 and the procedure for initiating the external process.

3. (c) Upon the request of the complainant, the health plan company must provide the complainant with a complete summary of the appeal decision.

   * NOTE: This section, as added by Laws 1999, chapter 239, *section 36, is effective April 1, 2000, and applies to contracts *issued or renewed on or after that date. Upon request, the *commissioner of health or commerce shall grant an extension of *up to three months to any health plan company or utilization *review organization that is unable to comply with Laws 1999, *chapter 239, sections 1, 3 to 42, and 43, paragraphs (a) and (c) *by April 1, 2000, due to circumstances beyond the control of the *health plan company or utilization review organization. Laws *1999, chapter 239, section 44.