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A BILL TO BE ENTITLED
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AN ACT
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relating to prompt payment of certain physicians and health care |
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providers by a preferred provider benefit plan. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1301.069, Insurance Code, is amended to |
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read as follows: |
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Sec. 1301.069. SERVICES PROVIDED BY CERTAIN PHYSICIANS AND |
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HEALTH CARE PROVIDERS. The provisions of this chapter relating to |
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prompt payment by an insurer of a physician or health care provider |
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and to verification of medical care or health care services apply to |
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a physician or provider who: |
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(1) is not a preferred provider included in the |
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preferred provider network; and |
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(2) provides to an insured: |
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(A) care related to an emergency or its attendant |
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episode of care as required by state or federal law; or |
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(B) specialty or other medical care or health |
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care services at the request of the insurer, [or] a preferred |
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provider, or an insured with out-of-network coverage [because the
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services are not reasonably available from a preferred provider who
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is included in the preferred delivery network]. |
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SECTION 2. The change in law made by this Act applies only |
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to payment of a claim submitted to an insurer for payment on or |
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after January 1, 2016. A claim submitted before January 1, 2016, is |
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governed by the law as it existed immediately before the effective |
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date of this Act, and that law is continued in effect for that |
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purpose. |
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SECTION 3. This Act takes effect September 1, 2015. |