Tex. Ins. Code § 1352.006 · Chapter 1352. BRAIN INJURY
DETERMINATION OF MEDICAL NECESSITY; EXTENSION OF COVERAGE.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(a) In this section, "utilization review" has the meaning assigned by Section 4201.002.
(b) Notwithstanding Chapter 4201 or any other law relating to the determination of medical necessity under this code, a health benefit plan shall respond to a person requesting utilization review or appealing for an extension of coverage based on an allegation of medical necessity not later than three business days after the date on which the person makes the request or submits the appeal. The person must make the request or submit the appeal in the manner prescribed by the terms of the plan's health insurance policy or agreement, contract, evidence of coverage, or similar coverage document. To comply with the requirements of this section, the health benefit plan issuer must respond through a direct telephone contact made by a representative of the issuer. This subsection does not apply to a small employer health benefit plan.
Notes and commentary — not statutory text
History
Added by Acts 2007, 80th Leg., R.S., Ch. 877 (H.B. 1919), Sec. 5, eff. September 1, 2007.
Source of truth
- Edition
- Current through the 89th 2nd Called Legislative Session, 2025
- Official file
- https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1352.htm
- Text hash
- sha256 bc723c9017269e2764ba7cada179d611dd732cba2dd2d15ed0b8749f3fd608eb
- 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
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