Tex. Ins. Code § 1301.053 · Subchapter B. RELATIONS WITH PHYSICIANS OR HEALTH CARE PROVIDERS
APPEAL RELATING TO DESIGNATION AS PREFERRED PROVIDER.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(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.
Notes and commentary — not statutory text
History
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Source of truth
- Edition
- Current through the 89th 2nd Called Legislative Session, 2025
- Official file
- https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1301.htm
- Text hash
- sha256 07cc12a472f5717ae2379b77e99c8d5167000ce55f1e2bb9c96b32af7fb84afc
- Composed by
- compose_tx.py 2026-10-05: the Legislative Council's chapter files read in document order; verify_tx.py's independent reading (lxml DOM walk) agrees character for character
Cited by 2 provisions
Provisions in this library whose text cites Tex. Ins. Code § 1301.053. Each shows the citation as that text prints it.
Procedural information only. Not legal advice and not a substitute for the advice of an attorney. Confirm the current text with the official publisher before relying on it.