Tex. Ins. Code §§ 1301.131 thorugh 1301.139: Preferred Provider Benefit Plans — Other Provisions Relating to Payment of Claims – Texas

Status: Enacted
Year Enacted: 2005
Year Amended: 2019
File: Download

Outlines the requirements necessary if a health insurance company requires prior authorization for services. Requirements include granting medically necessary services, and prohibited insurance companies from charging more or reducing payment to providers based on the necessity for prior authorization. On the request of a preferred provider for verification of a particular medical care or health care service the preferred provider proposes to provide to a particular patient, the insurer shall inform the preferred provider without delay whether the service, if provided to that patient, will be paid by the insurer and shall specify any deductibles, copayments, or coinsurance for which the insured is responsible. This statute also covers prior authorization and utilization review for preferred provider plans. An insurer that uses a preauthorization process for medical care or health care services shall make the requirements and information about the preauthorization process readily accessible to insureds, physicians, health care providers, and the general public by posting the requirements and information on the insurer’s Internet website.

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