Texas Insurance Code

§ 843.258 — APPEAL INVOLVING ONGOING EMERGENCY OR CONTINUED HOSPITALIZATION

IN § 843.258Title 6. ORGANIZATION OF INSURERS AND RELATED ENTITIES · Part C. LIFE, HEALTH, AND ACCIDENT INSURERS AND RELATED ENTITIES · Ch. 843. HEALTH MAINTENANCE ORGANIZATIONS · Art. G. DISPUTE RESOLUTION

Statute text

View on source

(a)The investigation and resolution of an appeal of a complaint relating to an ongoing emergency or denial of continued hospitalization shall be concluded:

(1)in accordance with the medical or dental immediacy of the case; and

(2)not later than one business day after the complainant's request for appeal is received.

(b)Because of the ongoing emergency or continued hospitalization and at the request of the complainant, the health maintenance organization shall provide, instead of a complaint appeal panel, a review by a physician or provider who:

(1)has not previously reviewed the case; and

(2)is of the same or a similar specialty as the physician or provider who would typically manage the medical condition, procedure, or treatment under consideration for review in the appeal.

…

Legislative history

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.