{"data":{"id":"us-tx/tex.-insurance-code-4201.456","jurisdiction":"us-tx","citation":"Tex. Insurance Code § 4201.456","heading":"OPPORTUNITY TO DISCUSS TREATMENT BEFORE ADVERSE DETERMINATION.","body":"Subject to the notice requirements of Subchapter G, before an adverse determination is issued by a specialty utilization review agent who questions the medical necessity, the appropriateness, or the experimental or investigational nature of a health care service, the agent shall provide the health care provider who ordered, requested, or is to provide the service a reasonable opportunity to discuss the patient's treatment plan and the clinical basis for the agent's determination with a health care provider who is of the same specialty as the agent.\nAdded by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.\nAmended by:\nActs 2009, 81st Leg., R.S., Ch. 1330 (H.B. 4290), Sec. 12, eff. September 1, 2009.\nActs 2019, 86th Leg., R.S., Ch. 1218 (S.B. 1742), Sec. 3.09, eff. September 1, 2019.","path":["INSURANCE CODE","TITLE 14. UTILIZATION REVIEW AND INDEPENDENT REVIEW","CHAPTER 4201. UTILIZATION REVIEW AGENTS","SUBCHAPTER J. SPECIALTY UTILIZATION REVIEW AGENTS"],"source_url":"https://statutes.capitol.texas.gov/Docs/IN/htm/IN.4201.htm#4201.456","current_through":"89th 2nd Called Legislative Session, 2025","vintage":"","retrieved_at":"2026-08-27T01:47:21Z","sha256":"2820b26d1f378f2db0e08fb64562d478cc8eb6d6e5bd9d586b47a38f5408a852","source_id":"us-tx","stale":false,"prev":"us-tx/tex.-insurance-code-4201.455","next":"us-tx/tex.-insurance-code-4201.457"},"notice":"GroundRules: Original legal text. Not legal advice."}