23 CAR § 15-113. Request for investigation

(a) The provisions of this section shall only apply to persons that are defined as health carriers under 23 CAR § 15-103(b)(8). (b)(1) A health claimant may file a consumer complaint with the Insurance Commissioner relating to a health carrier when there is a reasonable basis for such complaint due to the failure of the health carrier to process claims according to this rule. (2) However, if the health claimant is not the actual insured under the policy, nor the enrollee in the plan, the health claimant may file a consumer complaint with the commissioner where there is a reasonable basis to believe that the health carrier has exhibited a practice of not paying that provider's claims according to this rule. (c) The commissioner shall investigate such complaint and shall make a report of his or her findings available to the health claimant who filed the complaint.