Sec. 1301.069. SERVICES PROVIDED BY CERTAIN PHYSICIANS AND HEALTH CARE PROVIDERS. The provisions of this chapter relating to prompt payment by an insurer of a physician or health care provider and to verification of medical care or health care services apply to a physician or provider who:
(1) is not a preferred provider included in the preferred provider network; and
(2) provides to an insured:
(A) care related to an emergency or its attendant episode of care as required by state or federal law; or
(B) specialty or other medical care or health care services at the request of the insurer or a preferred provider because the services are not reasonably available from a preferred provider who is included in the preferred delivery network.
Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.037(d), eff. September 1, 2005.
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