Tex. Ins. Code §§ 1467.050 through 1467.060: Out of Network Claim Dispute Resolution — Mandatory Mediation for Out–of–Network Facilities – Texas

Status: Enacted
Year Enacted: 2009
Year Amended: 2019
File: Download

The commissioner shall establish and administer a mediation program to resolve disputes over out-of-network provider charges in accordance with this subchapter. An out-of-network provider or a health benefit plan issuer or administrator may request mediation of a settlement of an out-of-network health benefit claim through a portal on the department’s Internet website if there is an amount billed by the provider and unpaid by the issuer or administrator after copayments, deductibles, and coinsurance for which an enrollee may not be billed ; and the health benefit claim is for:
(A) emergency care;
(B) an out-of-network laboratory service; or
(C) an out-of-network diagnostic imaging service .

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