Texas § 4201.657 EFFECT OF APPEAL OR INDEPENDENT REVIEW DETERMINATION.

Texas Statutes

§ 4201.657 — EFFECT OF APPEAL OR INDEPENDENT REVIEW DETERMINATION.

Texas § 4201.657

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This text of Texas § 4201.657 (EFFECT OF APPEAL OR INDEPENDENT REVIEW 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.

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Tex. Insurance Code Code Ann. § 4201.657 (2026).

Text

Sec. 4201.657. EFFECT OF APPEAL OR INDEPENDENT REVIEW DETERMINATION.

(a)A health maintenance organization or insurer is bound by an appeal or independent review determination that does not affirm the determination made by the health maintenance organization or insurer to rescind a preauthorization exemption.

(b)A health maintenance organization or insurer may not retroactively deny a health care service on the basis of a rescission of an exemption, even if the health maintenance organization's or insurer's determination to rescind the preauthorization exemption is affirmed by an independent review organization.

(c)If a determination of a preauthorization exemption made by the health maintenance organization or insurer is overturned on review by an independent review organization, the he

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Sec. 4201.657. EFFECT OF APPEAL OR INDEPENDENT REVIEW DETERMINATION. (a) A health maintenance organization or insurer is bound by an appeal or independent review determination that does not affirm the determination made by the health maintenance organization or insurer to rescind a preauthorization exemption.
(b) A health maintenance organization or insurer may not retroactively deny a health care service on the basis of a rescission of an exemption, even if the health maintenance organization's or insurer's determination to rescind the preauthorization exemption is affirmed by an independent review organization.
(c) If a determination of a preauthorization exemption made by the health maintenance organization or insurer is overturned on review by an independent review organization, the health maintenance organization or insurer:
(1) may not attempt to rescind the exemption before the end of the next evaluation period that occurs; and
(2) may only rescind the exemption after if the health maintenance organization or insurer complies with Sections 4201.655 and 4201.656 .