Texas § IN.4201.206 - OPPORTUNITY TO DISCUSS TREATMENT BEFORE ADVERSE DETERMINATION
Full text of Texas The Texas Constitution § IN.4201.206 — OPPORTUNITY TO DISCUSS TREATMENT BEFORE ADVERSE DETERMINATION, with citation guidance and answers to common questions.
§ IN.4201.206. OPPORTUNITY TO DISCUSS TREATMENT BEFORE ADVERSE DETERMINATION
OPPORTUNITY TO DISCUSS TREATMENT BEFORE ADVERSE DETERMINATION. (a) Subject to Subsection (b) and the notice requirements of Subchapter G, before an adverse determination is issued by a 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, provided, or is to provide the service a reasonable opportunity to discuss with a physician licensed to practice medicine in this state the patient's treatment plan and the clinical basis for the agent's determination. (b) If the health care service described by Subsection (a) was ordered, requested, or provided, or is to be provided by a physician, the opportunity described by that subsection must be with a physician licensed to practice medicine in this state and who has the same or similar specialty as the physician. 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. 9, eff. September 1, 2009. Acts 2019, 86th Leg., R.S., Ch. 1218 (S.B. 1742 ), Sec. 3.03, eff. September 1, 2019. Acts 2021, 87th Leg., R.S., Ch. 1018 (H.B. 3459 ), Sec. 4, eff. September 1, 2021.
Source: official Texas text · Last verified 2026-08-27
Frequently Asked Questions About Texas § IN.4201.206
What does The Texas Constitution § IN.4201.206 cover?
Section IN.4201.206 ("OPPORTUNITY TO DISCUSS TREATMENT BEFORE ADVERSE DETERMINATION") is part of the The Texas Constitution, the codified statutory law of Texas. It sets out the legal rule or procedure described in the text above. Statutes are amended regularly, so always verify against the official source.
How do I cite Texas § IN.4201.206?
A common citation format is "The Texas Constitution § IN.4201.206" (Texas). Legal writing may require the code abbreviation, section number, and year or edition. Match the style required by your court, professor, or publisher.
Is this the official text of Texas law?
No. This page is for research and education and may not include the most recent amendments. For official current law, check the Texas official source linked on this page or consult a licensed Texas attorney.
How does Texas § IN.4201.206 apply to my situation?
Statutes are interpreted in context, and application depends on your specific facts. Only a licensed attorney in Texas can advise on how this section applies to you. Contact your state or local bar association for a referral.
Sources & Verification
Not legal advice. Verify against the official source and consult a licensed attorney in Texas.