Texas § IN.1456.001 - DEFINITIONS

§ IN.1456.001. DEFINITIONS

DEFINITIONS. In this chapter: (1) "Balance billing" means the practice of charging an enrollee in a health benefit plan that uses a provider network to recover from the enrollee the balance of a non-network health care provider's fee for service received by the enrollee from the health care provider that is not fully reimbursed by the enrollee's health benefit plan. (2) "Enrollee" means an individual who is eligible to receive health care services through a health benefit plan. (3) "Facility-based physician" means a radiologist, an anesthesiologist, a pathologist, an emergency department physician, a neonatologist, or an assistant surgeon: (A) to whom the facility has granted clinical privileges; and (B) who provides services to patients of the facility under those clinical privileges. (4) "Health care facility" means a hospital, emergency clinic, outpatient clinic, birthing center, ambulatory surgical center, or other facility providing health care services. (5) "Health care practitioner" means an individual who is licensed to provide and provides health care services. (6) "Provider network" means a health benefit plan under which health care services are provided to enrollees through contracts with health care providers and that requires those enrollees to use health care providers participating in the plan and procedures covered by the plan. The term includes a network operated by: (A) a health maintenance organization; (B) a preferred provider benefit plan issuer; or (C) another entity that issues a health benefit plan, including an insurance company. Added by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731 ), Sec. 11, eff. September 1, 2007. Amended by: Acts 2015, 84th Leg., R.S., Ch. 467 (S.B. 481 ), Sec. 2, eff. September 1, 2015.