Texas Insurance Code 1305.1545 – Restrictions On Payment and Reimbursement
(a) An insurance carrier or administrator may not reimburse a doctor or other health care provider, an institutional provider, or an organization of doctors and health care providers on a discounted fee basis for services that are provided to an injured employee unless:
(1) the carrier or administrator has contracted with either:
(A) the doctor or other health care provider, institutional provider, or organization of doctors and health care providers; or
(B) a network that has contracted with the doctor or other health care provider, institutional provider, or organization of doctors and health care providers; and
(2) the doctor or other health care provider, institutional provider, or organization of doctors and health care providers has agreed to the contract and has agreed to provide health care services under the terms of the contract.
(b) A party to a carrier-network contract may not sell, lease, or otherwise transfer information regarding the payment or reimbursement terms of the contract without the express authority of and prior adequate notification to the other contracting parties. This subsection does not affect the authority of the commissioner under this code to request and obtain information.
Terms Used In Texas Insurance Code 1305.1545
- Contract: A legal written agreement that becomes binding when signed.
- Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
- Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
(c) An insurance carrier or administrator who violates this section:
(1) commits an unfair claim settlement practice in violation of Subchapter A, Chapter 542, Insurance Code; and
(2) is subject to administrative penalties under Chapters 82 and 84, Insurance Code.