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Texas Statutes (Last Updated: January 4, 2014) |
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INSURANCE CODE |
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Title 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES |
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Subtitle F. PHYSICIANS AND HEALTH CARE PROVIDERS |
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Chapter 1467. OUT-OF-NETWORK CLAIM DISPUTE RESOLUTION |
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Subchapter B. MANDATORY MEDIATION |
Sec. 1467.054. REQUEST AND PRELIMINARY PROCEDURES FOR MANDATORY MEDIATION
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(a) An enrollee may request mandatory mediation under this chapter.
(b) A request for mandatory mediation must be provided to the department on a form prescribed by the commissioner and must include:
(1) the name of the enrollee requesting mediation;
(2) a brief description of the claim to be mediated;
(3) contact information, including a telephone number, for the requesting enrollee and the enrollee's counsel, if the enrollee retains counsel;
(4) the name of the facility-based physician and name of the insurer or administrator; and
(5) any other information the commissioner may require by rule.
(c) On receipt of a request for mediation, the department shall notify the facility-based physician and insurer or administrator of the request.
(d) In an effort to settle the claim before mediation, all parties must participate in an informal settlement teleconference not later than the 30th day after the date on which the enrollee submits a request for mediation under this section.
(e) A dispute to be mediated under this chapter that does not settle as a result of a teleconference conducted under Subsection (d) must be conducted in the county in which the medical services were rendered.
(f) The enrollee may elect to participate in the mediation. A mediation may not proceed without the consent of the enrollee. An enrollee may withdraw the request for mediation at any time before the mediation.
(g) Notwithstanding Subsection (f), mediation may proceed without the participation of the enrollee or the enrollee's representative if the enrollee or representative is not present in person or through teleconference.