Del. Code Ann. tit. 18, § 332 - Arbitration of disputes involving health insurance coverage

Each health insurer must establish an internal review process that is approved by the insurance commissioner. Health insurance enrollees have the right to submit an oral or written request for internal review of adverse determinations within 30 days of receiving written notice of an adverse determination. Health insurers must acknowledge receipt of an enrollee’s grievance within 5 days of receiving it. Health insurers are obligated to address grievances in an efficient manner; thus, they must resolve grievances within 72 hours for grievances that relate to emergencies, 30 days for grievances relating to referrals or benefit determinations, and 45 days for other matters. Enrollees must be provided with a written notice of the disposition of the grievance and a notification that the Insurance Department has mediation services that the enrollee can use to appeal a health insurer’s final decision.