Tex. Ins. Code § 4201.359 · Subchapter H. APPEAL OF ADVERSE DETERMINATION
NOTICE OF APPEAL.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(a) The procedures for appealing an adverse determination must require written notice to the appealing party of the determination of the appeal as soon as practicable, but not later than the 30th calendar day, after the date the utilization review agent receives the appeal.
(b) If the appeal is denied, the notice must include a clear and concise statement of:
(1) the clinical basis for the denial;
(2) the specialty of the physician or other health care provider making the denial; and
(3) the appealing party's right to seek review of the denial by an independent review organization under Subchapter I and the procedures for obtaining that review.
Notes and commentary — not statutory text
History
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 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.4201.htm
- Text hash
- sha256 331211cfa1ae62a8606658883ff13af5101131986fd14b7376883ca87c54c95e
- 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 1 provision
Provisions in this library whose text cites Tex. Ins. Code § 4201.359. 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.