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Texas Insurance Code - INS § 1451.2065. Contracts with Dentists

Current as of January 01, 2024 | Updated by Findlaw Staff

(a) In this section:

(1) “Covered service” means a dental care service for which reimbursement is available under a patient's employee benefit plan or health insurance policy, or for which reimbursement is available subject to a contractual limitation, including:

(A) a deductible;

(B) a copayment;

(C) coinsurance;

(D) a waiting period;

(E) an annual or lifetime maximum limit;

(F) a frequency limitation;

(G) an alternative benefit payment;  or

(H) any other limitation.

(2) “Insurer” means a provider or issuer of an employee benefit plan or health insurance policy.

(b) A contract between an insurer and a dentist may not:

(1) limit the fee the dentist may charge for a service that is not a covered service; or

(2) include a provision that both:

(A) allows the insurer to disallow a service, resulting in denial of payment to the dentist for a service that ordinarily would have been covered;  and

(B) prohibits the dentist from billing for and collecting the amount owed from the patient for that service if there is a dental necessity, as defined by Section 32.054, Human Resources Code, for that service.

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Cite this article: FindLaw.com - Texas Insurance Code - INS § 1451.2065. Contracts with Dentists - last updated January 01, 2024 | https://codes.findlaw.com/tx/insurance-code/ins-sect-1451-2065/

FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.

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