Tex. Ins. Code Section 1452.207
Enrollee Held Harmless

An enrollee in the managed care plan is not responsible and shall be held harmless for the difference between in-network copayments paid by the enrollee to a therapeutic optometrist who is determined to be ineligible under Section 1452.206 (Effect of Failure to Meet Credentialing Requirements) and the managed care plan’s charges for out-of-network services. The therapeutic optometrist and the therapeutic optometrist’s professional practice may not charge the enrollee for any portion of the therapeutic optometrist’s fee that is not paid or reimbursed by the enrollee’s managed care plan.

Added by Acts 2013, 83rd Leg., R.S., Ch. 79 (S.B. 365), Sec. 1, eff. September 1, 2013.

Source: Section 1452.207 — Enrollee Held Harmless, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1452.htm#1452.207 (accessed Jun. 5, 2024).

1452.001
Applicability of Certain Definitions 1452.002
Verification of Physician’s License or Certificate 1452.003
Site Visit for Initial Credentialing 1452.004
Limitation on Commissioner’s Authority 1452.005
Site Visit for Cause Not Precluded 1452.006
Rules Related to Selection of Physicians and Providers by Health Maintenance Organization 1452.051
Definitions 1452.052
Standardized Form for Verification of Credentials 1452.101
Definitions 1452.102
Applicability 1452.103
Eligibility Requirements 1452.104
Payment of Applicant Physician During Credentialing Process 1452.105
Directory Entries 1452.106
Effect of Failure to Meet Credentialing Requirements 1452.107
Enrollee Held Harmless 1452.108
Limitation on Managed Care Issuer Liability 1452.151
Definitions 1452.152
Applicability 1452.153
Eligibility Requirements 1452.154
Payment of Applicant Podiatrist During Credentialing Process 1452.155
Directory Entries 1452.156
Effect of Failure to Meet Credentialing Requirements 1452.157
Enrollee Held Harmless 1452.158
Limitation on Managed Care Issuer Liability 1452.201
Definitions 1452.202
Applicability 1452.203
Eligibility Requirements 1452.204
Payment of Applicant Therapeutic Optometrist During Credentialing Process 1452.205
Directory Entries 1452.206
Effect of Failure to Meet Credentialing Requirements 1452.207
Enrollee Held Harmless 1452.208
Limitation on Managed Care Issuer Liability

Accessed:
Jun. 5, 2024

§ 1452.207’s source at texas.gov

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Location: https://texas.public.law/statutes/tex._ins._code_section_1452.207

Original Source: Section 1452.207 — Enrollee Held Harmless, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1452.htm#1452.207 (last accessed Jun. 5, 2024).