Subject to the notice requirements of Subchapter G, before an adverse determination is issued by a specialty utilization review agent who questions the medical necessity, the appropriateness, or the experimental or investigational nature of a health care service, the agent shall provide the health care provider who ordered, requested, or is to provide the service a reasonable opportunity to discuss the patient's treatment plan and the clinical basis for the agent's determination with a health care provider who is of the same specialty as the agent.
Tex. Ins. Code § 4201.456
OPPORTUNITY TO DISCUSS TREATMENT BEFORE ADVERSE DETERMINATION
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff
Official source: Texas Constitution and Statutes. Reproduced from public-domain Texas statutes; confirm against the official source for the current text. Not legal advice.