Texas § 1301.053 APPEAL RELATING TO DESIGNATION AS PREFERRED PROVIDER.

Texas Statutes

§ 1301.053 — APPEAL RELATING TO DESIGNATION AS PREFERRED PROVIDER.

Texas § 1301.053

Code INInsurance Code

This text of Texas § 1301.053 (APPEAL RELATING TO DESIGNATION AS PREFERRED PROVIDER.) is published on Counsel Stack Legal Research, covering Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Tex. Insurance Code Code Ann. § 1301.053 (2026).

Text

Sec. 1301.053. APPEAL RELATING TO DESIGNATION AS PREFERRED PROVIDER.

(a)An insurer that does not designate a practitioner as a preferred provider shall provide a reasonable mechanism for reviewing that action. The review mechanism must incorporate, in an advisory role only, a review panel.

(b)A review panel must be composed of at least three individuals selected by the insurer from a list of participating practitioners and must include one member who is a practitioner in the same or similar specialty as the affected practitioner, if available. The practitioners contracting with the insurer in the applicable service area shall provide the list of practitioners to the insurer.

(c)On request, the insurer shall provide to the affected practitioner:

(1)the panel's recommendation, if any; an

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Sec. 1301.053. APPEAL RELATING TO DESIGNATION AS PREFERRED PROVIDER. (a) An insurer that does not designate a practitioner as a preferred provider shall provide a reasonable mechanism for reviewing that action. The review mechanism must incorporate, in an advisory role only, a review panel.
(b) A review panel must be composed of at least three individuals selected by the insurer from a list of participating practitioners and must include one member who is a practitioner in the same or similar specialty as the affected practitioner, if available. The practitioners contracting with the insurer in the applicable service area shall provide the list of practitioners to the insurer.
(c) On request, the insurer shall provide to the affected practitioner:
(1) the panel's recommendation, if any; and
(2) a written explanation of the insurer's determination, if that determination is contrary to the panel's recommendation.