Tex. Insurance Code § 843.255
COMPOSITION OF COMPLAINT APPEAL PANEL
Texas · Texas Insurance Code · Status: effective
Cite this
- Citation
- Tex. Insurance Code § 843.255, COMPOSITION OF COMPLAINT APPEAL PANEL, Texas, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/679477
- Permanent ID
ys:prov:679477@1- SHA-256
5d78b3ae644f881d952a529cbbeb73668900f74663c0e087799ab1ca3a8791ba
The hash is SHA-256 of this version's text, with every run of whitespace collapsed to a single space and the ends trimmed. The ID always leads back here, and checking it says whether the text you cited is still the current version.
Full text
(a) A health maintenance organization shall appoint members to a complaint appeal panel to advise the health maintenance organization on the resolution of a disputed decision appealed by a complainant.
(b) A complaint appeal panel shall be composed of an equal number of health maintenance organization staff members, physicians or other providers, and enrollees. A member of a complaint appeal panel may not have been previously involved in the disputed decision.
(c) The physicians or other providers on a complaint appeal panel must have experience in the area of care that is in dispute and must be independent of any physician or provider who made any previous determination. If specialty care is in dispute, the complaint appeal panel must include a person who is a specialist in the field of care to which the appeal relates.
(d) The enrollee members of a complaint appeal panel may not be employees of the health maintenance organization.