Sec. 4201.354. PERSONS OR ENTITIES WHO MAY APPEAL. The procedures for appealing an adverse determination must provide that the adverse determination may be appealed orally or in writing by:
(1) an enrollee;
(2) a person acting on the enrollee's behalf; or
(3) the enrollee's physician or other health care provider.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.
Structure Texas Statutes
Title 14 - Utilization Review and Independent Review
Chapter 4201 - Utilization Review Agents
Subchapter H. Appeal of Adverse Determination
Section 4201.351. Complaint as Appeal
Section 4201.352. Written Description of Appeal Procedures
Section 4201.353. Appeal Procedures Must Be Reasonable
Section 4201.354. Persons or Entities Who May Appeal
Section 4201.355. Acknowledgment of Appeal
Section 4201.356. Decision by Physician Required; Specialty Review
Section 4201.358. Response Letter to Interested Persons