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Texas Insurance Code - INS § 4201.401. Review by Independent Review Organization; Compliance with Independent Determination

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

(a) A utilization review agent shall allow any party whose appeal of an adverse determination is denied by the agent to seek review of that determination by an independent review organization assigned to the appeal in accordance with Chapter 4202.

(b) The utilization review agent shall comply with the independent review organization's determination regarding the medical necessity or appropriateness of health care items and services for an enrollee.

(c) The utilization review agent shall comply with the independent review organization's determination regarding the experimental or investigational nature of health care items and services for an enrollee.

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Cite this article: FindLaw.com - Texas Insurance Code - INS § 4201.401. Review by Independent Review Organization; Compliance with Independent Determination - last updated January 01, 2024 | https://codes.findlaw.com/tx/insurance-code/ins-sect-4201-401/

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