SUBMITTING COMPLAINTS TO DEPARTMENT

(a) Any person, including a person who has attempted to resolve a complaint through a health maintenance organization's complaint system process and is dissatisfied with the resolution, may submit a complaint to the department alleging a violation of: (1) this chapter; (2) Section 1367.053; (3) Subchapter A, Chapter 1452; (4) Subchapter B, Chapter 1507; (5) Chapters 222, 251, and 258, as applicable to a health maintenance organization; or (6) Chapter 1271 or 1272. (b) The commissioner shall complete an investigation of a complaint against a health maintenance organization to determine whether a violation has occurred not later than the 60th day after the date the department receives the complaint and all information necessary for the commissioner to make a determination. (c) The commissioner may extend the time necessary to complete an investigation if: (1) additional information is needed; (2) an on-site review is necessary; (3) the health maintenance organization, the physician or provider, or the complainant does not provide all documentation necessary to complete the investigation; or (4) other circumstances beyond the control of the department occur.