Texas § IN.1301.0058 - PROTECTED COMMUNICATIONS BY PREFERRED PROVIDERS

§ IN.1301.0058. PROTECTED COMMUNICATIONS BY PREFERRED PROVIDERS

PROTECTED COMMUNICATIONS BY PREFERRED PROVIDERS. (a) An insurer may not in any manner prohibit, attempt to prohibit, penalize, terminate, or otherwise restrict a preferred provider from communicating with an insured about the availability of out-of-network providers for the provision of the insured's medical or health care services. (b) An insurer may not terminate the contract of or otherwise penalize a preferred provider solely because the provider's patients use out-of-network providers for medical or health care services. (c) An insurer's contract with a preferred provider may require that, except in a case of a medical emergency as determined by the preferred provider, before the provider may make an out-of-network referral for an insured, the preferred provider inform the insured: (1) that: (A) the insured may choose a preferred provider or an out-of-network provider; and (B) if the insured chooses the out-of-network provider the insured may incur higher out-of-pocket expenses; and (2) whether the preferred provider has a financial interest in the out-of-network provider. Added by Acts 2015, 84th Leg., R.S., Ch. 275 (H.B. 574 ), Sec. 5, eff. September 1, 2015.