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Tdi complaint for providers Form: What You Should Know

TDM.  3.9215 — Tex. Admin. Code § 33.07.098. This document provides instructions for filing a complaint to TDI with TDI. What Happens During the Investigation of a Complaint During an investigation, you will receive a written summary of your case as a result of our investigation. You can request a copy of the summary, or you may wish to bring your complaint to TDI to have it read to you orally.  During the oral presentation, TDI staff will provide you with the written version of your complaint. If you need to give us information about yourself or your insurer, then you must provide your driver's license, social security number (not a private social security number for a non-U.S citizen), and your health insurance information. We will collect this information, so we know we have all the information needed to address any inquiries you may have. The oral presentation will be limited to you alone. You will not be able to have your case read to any witnesses. (See “When You Can Call Witness” in Chapter 3.9215.) If your complaint is determined to be justified in terms of the medical care, it should be documented in your report. The report may be kept on file for a minimum of 4 years if the case is closed under the process set forth in this statute, provided you have provided the information we requested prior to your hearing, including relevant documents such as a billing statement or a note from your doctor. If you have a complaint related to billing, you will have the opportunity to file a complaint based upon the billing of benefits. TDI will also be able to provide you with the documentation needed to substantiate your complaint. After You Have Heard Your Case You will receive a copy of the written report and information you requested about your hearing.  You may appeal TDI's decision and/or request a jury trial where you do not appear in person. After you receive your hearing brief, you may file your written complaint to TDI with TDI within 14 days of the date you receive your brief. You will receive a reply from TDI within 45 days of the date the brief was sent to you. 3.9220 — Tex. Admin. Code § 33.07.098. What You Must Do If You Are the Complainant In addition to the oral presentation, you may request an attorney to represent you.

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