Texas Insurance Code - INS § 4201.456. Opportunity to Discuss Treatment Before Adverse Determination

Subject to the notice requirements of Subchapter G,  1 before an adverse determination is issued by a specialty utilization review agent who questions the medical necessity, the appropriateness, or the experimental or investigational nature of a health care service, the agent shall provide the health care provider who ordered, requested, or is to provide the service a reasonable opportunity to discuss the patient's treatment plan and the clinical basis for the agent's determination with a health care provider who is of the same specialty as the agent.