Texas § IN.1301.051 - DESIGNATION AS PREFERRED PROVIDER

§ IN.1301.051. DESIGNATION AS PREFERRED PROVIDER

DESIGNATION AS PREFERRED PROVIDER. (a) An insurer shall afford a fair, reasonable, and equivalent opportunity to apply to be and to be designated as a preferred provider to practitioners and institutional providers and to health care providers other than practitioners and institutional providers, if those other health care providers are included by the insurer as preferred providers, provided that the practitioners, institutional providers, or health care providers: (1) are licensed to treat injuries or illnesses or to provide services covered by a health insurance policy; and (2) comply with the terms established by the insurer for designation as preferred providers. (b) An insurer may not unreasonably withhold a designation as a preferred provider. (c) An insurer shall give a physician or health care provider who, on the person's initial application, is not designated as a preferred provider written reasons for denial of the designation. (d) Unless otherwise limited by this code, this section does not prohibit an insurer from rejecting a physician's or health care provider's application for designation based on a determination that the preferred provider benefit plan has sufficient qualified providers. (e) An insurer may not withhold a designation to: (1) a podiatrist described by Section 1301.0521 ; or (2) an optometrist, therapeutic optometrist, or ophthalmologist described by Section 1301.0522 . Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005. Amended by: Acts 2005, 79th Leg., Ch. 728 (H.B. 2018 ), Sec. 11.034(a), eff. September 1, 2005. Acts 2015, 84th Leg., R.S., Ch. 1271 (S.B. 684 ), Sec. 1, eff. September 1, 2015.