Sec. 1452.107. ENROLLEE HELD HARMLESS. An enrollee in the managed care plan is not responsible and shall be held harmless for the difference between in-network copayments paid by the enrollee to a physician who is determined to be ineligible under Section 1452.106 and the managed care plan's charges for out-of-network services. The physician and the physician's medical group may not charge the enrollee for any portion of the physician's fee that is not paid or reimbursed by the enrollee's managed care plan.
Added by Acts 2007, 80th Leg., R.S., Ch. 1203 (H.B. 1594), Sec. 1, eff. September 1, 2007.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Subtitle F - Physicians and Health Care Providers
Chapter 1452 - Physician and Provider Credentials
Subchapter C. Expedited Credentialing Process
Section 1452.102. Applicability
Section 1452.103. Eligibility Requirements
Section 1452.104. Payment of Applicant Physician During Credentialing Process
Section 1452.105. Directory Entries
Section 1452.106. Effect of Failure to Meet Credentialing Requirements
Section 1452.107. Enrollee Held Harmless
Section 1452.108. Limitation on Managed Care Issuer Liability