Sec. 1301.051. DESIGNATION AS PREFERRED PROVIDER. (a) An insurer shall afford a fair, reasonable, and equivalent opportunity to apply to be and to be designated as a preferred provider to practitioners and institutional providers and to health care providers other than practitioners and institutional providers, if those other health care providers are included by the insurer as preferred providers, provided that the practitioners, institutional providers, or health care providers:
(1) are licensed to treat injuries or illnesses or to provide services covered by a health insurance policy; and
(2) comply with the terms established by the insurer for designation as preferred providers.
(b) An insurer may not unreasonably withhold a designation as a preferred provider.
(c) An insurer shall give a physician or health care provider who, on the person's initial application, is not designated as a preferred provider written reasons for denial of the designation.
(d) Unless otherwise limited by this code, this section does not prohibit an insurer from rejecting a physician's or health care provider's application for designation based on a determination that the preferred provider benefit plan has sufficient qualified providers.
(e) An insurer may not withhold a designation to:
(1) a podiatrist described by Section 1301.0521; or
(2) an optometrist, therapeutic optometrist, or ophthalmologist described by Section 1301.0522.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.034(a), eff. September 1, 2005.
Acts 2015, 84th Leg., R.S., Ch. 1271 (S.B. 684), Sec. 1, eff. September 1, 2015.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Chapter 1301 - Preferred Provider Benefit Plans
Subchapter B. Relations With Physicians or Health Care Providers
Section 1301.051. Designation as Preferred Provider
Section 1301.0515. Acupuncturist Services
Section 1301.0516. Chiropractic Services
Section 1301.0521. Designation of Certain Podiatrists as Preferred Providers
Section 1301.053. Appeal Relating to Designation as Preferred Provider
Section 1301.054. Notice to Practitioners of Preferred Provider Benefit Plan
Section 1301.055. Complaint Resolution
Section 1301.056. Restrictions on Payment and Reimbursement
Section 1301.057. Termination of Participation; Expedited Review Process
Section 1301.058. Economic Profiling
Section 1301.059. Quality Assessment
Section 1301.060. Compensation on Discounted Fee Basis
Section 1301.061. Preferred Provider Networks
Section 1301.062. Preferred Provider Contracts Between Insurers and Podiatrists
Section 1301.0625. Health Care Collaboratives
Section 1301.063. Contract Provisions Relating to Use of Hospitalist
Section 1301.064. Contract Provisions Relating to Payment of Claims
Section 1301.0641. Contract Provisions Prohibiting Rejection of Batched Claims
Section 1301.065. Shifting of Insurer's Tort Liability Prohibited
Section 1301.066. Retaliation Against Preferred Provider Prohibited
Section 1301.068. Inducement to Limit Medically Necessary Services Prohibited
Section 1301.069. Services Provided by Certain Physicians and Health Care Providers