Tex. Ins. Code § 1467.056 · Subchapter B. MANDATORY MEDIATION FOR OUT-OF-NETWORK FACILITIES
MATTERS CONSIDERED IN MEDIATION; AGREED RESOLUTION.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(a) In a mediation under this subchapter, the parties shall evaluate whether:
(1) the amount charged by the out-of-network provider for the health care or medical service or supply is excessive; and
(2) the amount paid by the health benefit plan issuer or administrator represents the usual and customary rate for the health care or medical service or supply or is unreasonably low.
(b) The out-of-network provider may present information regarding the amount charged for the health care or medical service or supply. The health benefit plan issuer or administrator may present information regarding the amount paid by the issuer or administrator.
(c) Nothing in this chapter prohibits mediation of more than one claim between the parties during a mediation.
(d) The goal of the mediation is to reach an agreement between the out-of-network provider and the health benefit plan issuer or administrator, as applicable, as to the amount paid by the issuer or administrator to the out-of-network provider and the amount charged by the out-of-network provider.
Notes and commentary — not statutory text
History
Added by Acts 2009, 81st Leg., R.S., Ch. 1290 (H.B. 2256), Sec. 1, eff. June 19, 2009.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 100 (S.B. 507), Sec. 11, eff. September 1, 2017.
Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 2.12, eff. September 1, 2019.
Source of truth
- Edition
- Current through the 89th 2nd Called Legislative Session, 2025
- Official file
- https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1467.htm
- Text hash
- sha256 b8425abd5188adc0deb66eae5b5b439c9fe35c023b724b17620f83792685f54a
- 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
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.