The commissioner and the Texas Medical Board, or another appropriate regulator, must adopt complaint-review rules for out-of-network health benefit claims.
Sec. 1467.151. CONSUMER PROTECTION; RULES. (a) The commissioner and the Texas Medical Board or other regulatory agency, as appropriate, shall adopt rules regulating the investigation and review of a complaint filed that relates to the settlement of an out-of-network health benefit claim that is subject to this chapter. The rules adopted under this section must: (1) distinguish among complaints for out-of-network coverage or payment and give priority to investigating allegations of delayed health care or medical care; (2) develop a form for filing a complaint; and (3) ensure that a complaint is not dismissed without appropriate consideration. (b) The department and the Texas Medical Board or other appropriate regulatory agency shall maintain information on each complaint filed that concerns a claim, arbitration, or mediation subject to this chapter, including: (1) the type of services or supplies that gave rise to the dispute; (2) the type and specialty, if any, of the out-of-network provider who provided the out-of-network service or supply; (3) the county and metropolitan area in which the health care or medical service or supply was provided; (4) whether the health care or medical service or supply was for emergency care; and (5) any other information about: (A) the health benefit plan issuer or administrator that the commissioner by rule requires; or (B) the out-of-network provider that the Texas Medical Board or other appropriate regulatory agency by rule requires. (c) The information collected and maintained under Subsection (b) is public information as defined by Section 552.002, Government Code, and may not include personally identifiable information or health care or medical information. (d) Repealed by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 3.03(11), eff. September 1, 2019. Added by Acts 2009, 81st Leg., R.S., Ch. 1290 (H.B. 2256), Sec. 1, eff. June 19, 2009. Amended by: Acts 2017, 85th Leg., R.S., Ch. 100 (S.B. 507), Sec. 16, eff. September 1, 2017. Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 2.17, eff. September 1, 2019. Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 3.03(11), eff. September 1, 2019.