Texas § 4201.456 OPPORTUNITY TO DISCUSS TREATMENT BEFORE ADVERSE DETERMINATION.

Texas Statutes

§ 4201.456 — OPPORTUNITY TO DISCUSS TREATMENT BEFORE ADVERSE DETERMINATION.

Texas § 4201.456

Code INInsurance Code

This text of Texas § 4201.456 (OPPORTUNITY TO DISCUSS TREATMENT BEFORE ADVERSE DETERMINATION.) 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. § 4201.456 (2026).

Text

Sec. 4201.456. OPPORTUNITY TO DISCUSS TREATMENT BEFORE ADVERSE DETERMINATION. 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.

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Sec. 4201.456. OPPORTUNITY TO DISCUSS TREATMENT BEFORE ADVERSE DETERMINATION. 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.

Legislative History

Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017 ), Sec. 4, eff. April 1, 2007. Amended by: Acts 2009, 81st Leg., R.S., Ch. 1330 (H.B. 4290 ), Sec. 12, eff. September 1, 2009. Acts 2019, 86th Leg., R.S., Ch. 1218 (S.B. 1742 ), Sec. 3.09, eff. September 1, 2019.