Tex.
Ins. Code Section 1215.004
Request for Additional Information
(a)
On receipt of the report required by Section 1215.003 (Receipt of and Response to Request for Claim Information)(a), the plan, plan sponsor, or plan administrator may review the report and, not later than the 10th day after the date the report is received, may make a written request to the health insurance issuer for additional information in accordance with this section for specified individuals.(b)
With respect to a request for additional information concerning specified individuals for whom claims information has been provided under Section 1215.003 (Receipt of and Response to Request for Claim Information)(c)(5), the health insurance issuer shall provide additional information on the prognosis or recovery if available and, for individuals in active case management, the most recent case management information, including any future expected costs and treatment plan, that relate to the claims for that individual.(c)
The health insurance issuer must respond to the request for additional information under this section not later than the 15th day after the date of the request under this section unless the requesting plan, plan sponsor, or plan administrator agrees to a request for additional time.(d)
The health insurance issuer is not required to produce the report described by this section unless a certification has been provided in accordance with Section 1215.003 (Receipt of and Response to Request for Claim Information)(e).
Source:
Section 1215.004 — Request for Additional Information, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1215.htm#1215.004 (accessed May 18, 2024).
