With whom may the subscriber of an HIC file an appeal regarding the resolution of a complaint concerning services provided?

• A. Superintendent of Insurance
• B. Peer Review Committee
• C. HIC Policy Administrator
• D. Ohio Chief of Medicine

Answer: (B)

The main idea is that disputes about the quality and appropriateness of medical services are reviewed by a panel of their peers. The Peer Review Committee is made up of clinicians who examine medical records, assess whether the care provided met established professional standards, and issue findings or recommendations based on those clinical evaluations. Because the appeal concerns whether the services were appropriate and of acceptable quality, this clinical review body is the proper forum for resolution.

Regulatory or administrative bodies—like a state insurance regulator—focus on compliance and policy issues rather than evaluating the medical merits of a specific case. An internal policy administrator handles policy administration, not independent medical quality review. And a government medical office without a defined clinical appeal role isn’t the venue for deciding on the specifics of a service-related complaint.