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Texas Insurance Code - INS § 843.305. Annual Application Period for Physicians and Providers to contract

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

(a) This section applies only to a health maintenance organization that provides coverage for health care services through:

(1) one or more physicians or providers who are not partners or employees of the health maintenance organization;  or

(2) one or more physicians or providers who are not owned or operated by the health maintenance organization.

(b) A health maintenance organization shall provide a period of 20 calendar days each calendar year during which any physician or provider in a service area may, under the terms established by the health maintenance organization for the provision of services and the designation of physicians and providers, apply to participate in providing health care services.

(c) A health maintenance organization that denies the application of a physician or provider shall notify the physician or provider in writing of the reason for the denial.

(d) This section does not require that a health maintenance organization:

(1) use a particular type of physician or provider in its operation;

(2) accept a physician or provider of a category or type that does not meet the practice standards and qualifications established by the health maintenance organization;  or

(3) contract directly with physicians or providers of a particular category or type.

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Cite this article: FindLaw.com - Texas Insurance Code - INS § 843.305. Annual Application Period for Physicians and Providers to contract - last updated January 01, 2024 | https://codes.findlaw.com/tx/insurance-code/ins-sect-843-305/

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