GroundRules
Tex. Insurance Code § 1301.053: APPEAL RELATING TO DESIGNATION AS PREFERRED PROVIDER.
Where this section sits in the code
- INSURANCE CODE
- TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES
- SUBTITLE D. PROVIDER PLANS
- CHAPTER 1301. PREFERRED PROVIDER BENEFIT PLANS
- SUBCHAPTER B. RELATIONS WITH PHYSICIANS OR HEALTH CARE PROVIDERS
(a) An insurer that does not designate a practitioner as a preferred provider shall provide a reasonable mechanism for reviewing that action. The review mechanism must incorporate, in an advisory role only, a review panel.
(b) A review panel must be composed of at least three individuals selected by the insurer from a list of participating practitioners and must include one member who is a practitioner in the same or similar specialty as the affected practitioner, if available. The practitioners contracting with the insurer in the applicable service area shall provide the list of practitioners to the insurer.
(c) On request, the insurer shall provide to the affected practitioner:
(1) the panel's recommendation, if any; and
(2) a written explanation of the insurer's determination, if that determination is contrary to the panel's recommendation.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Collected 2026-08-27T01:47:21Z. Source file · JSON