Tex. Ins. Code § 1301.0052. Exclusive Provider Benefit Plans: Referrals for Medically Necessary Services: Preferred Provider Benefit Plans – Texas

Status: Enacted
Year Enacted: 2011
File: Download

If a covered service is medically necessary and is not available through a preferred provider, the issuer of an exclusive provider benefit plan, on the request of a preferred provider, shall: approve the referral of an insured to a nonpreferred provider within a reasonable period; and fully reimburse the nonpreferred provider at the usual and customary rate agreed to by the issuer and the nonpreferred provider.

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