Subject to the notice requirements of Subchapter G, before an adverse determination is issued by a specialty utilization review agent who questions the medical necessity, the appropriateness, or the experimental or investigational nature of a health care service, the agent shall provide the health care provider who ordered, requested, or is to provide the service a reasonable opportunity to discuss the patient’s treatment plan and the clinical basis for the agent’s determination with a health care provider who is of the same specialty as the agent.

Added by Acts 2005, 79th Leg., ch. 727, § 4, eff. April 1, 2007. Amended by Acts 2009, 81st Leg., ch. 1330, § 12, eff. Sept. 1, 2009; Acts 2019, 86th Leg., ch. 1218 (S.B. 1742), § 3.09, eff. Sept. 1, 2019.