Tex.
Ins. Code Section 1451.2065
Contracts with Dentists
(a)
In this section:(1)
“Covered service” means a dental care service for which reimbursement is available under a patient’s employee benefit plan or health insurance policy, or for which reimbursement is available subject to a contractual limitation, including:(A)
a deductible;(B)
a copayment;(C)
coinsurance;(D)
a waiting period;(E)
an annual or lifetime maximum limit;(F)
a frequency limitation;(G)
an alternative benefit payment; or(H)
any other limitation.(2)
“Insurer” means a provider or issuer of an employee benefit plan or health insurance policy.(b)
A contract between an insurer and a dentist may not:(1)
limit the fee the dentist may charge for a service that is not a covered service; or(2)
include a provision that both:(A)
allows the insurer to disallow a service, resulting in denial of payment to the dentist for a service that ordinarily would have been covered; and(B)
prohibits the dentist from billing for and collecting the amount owed from the patient for that service if there is a dental necessity, as defined by Section 32.054 (Dental Services), Human Resources Code, for that service.
Source:
Section 1451.2065 — Contracts with Dentists, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1451.htm#1451.2065 (accessed May 26, 2025).
