This is a clone of the Texas Administrative Code (TAC) for educational purposes. It is not the official version and should not be used for legal purposes. Site created Wed, 21 May 2025 21:16:50 GMT

TITLE 28 - INSURANCE
PART 1 - TEXAS DEPARTMENT OF INSURANCE
CHAPTER 21 - TRADE PRACTICES
SUBCHAPTER 21.5030.html - null
SECTION/RULE §21.5030 - Complaint Resolution
Chapter Review Date 06/08/2021

(a) Written complaint. A party may submit a written complaint on the department's website regarding the settlement of an out-of-network health benefit claim that is subject to Insurance Code Chapter 1467.(b) Complaint information. The recommended information for filing a complaint under subsection (a) of this section includes:(1) whether the complaint is within the scope of Insurance Code Chapter 1467 (concerning Out-of-Network Claim Dispute Resolution);(2) whether emergency care, health care, or a medical service has been delayed or has not been given;(3) whether the health care, medical service, or supply, or a combination of health care, medical service, or supply, that is the subject of the complaint was for emergency care; and(4) specific information about the qualified mediation claim or qualified arbitration claim, including:(A) the name, type, and specialty of the provider;(B) the type of service performed or supplies provided;(C) the city and county where the service or supply was performed; and(D) the dollar amount of the disputed claim.(c) Department processing. The department will maintain procedures to ensure that a written complaint made through the department's website under this section is not dismissed without appropriate consideration, including:(1) review of all of the information submitted in the written complaint;(2) contact with the parties that are the subject of the complaint; and(3) review of the responses received from the subjects of the complaint to determine if and what further action is required, as appropriate.

Source Note: The provisions of this §21.5030 adopted to be effective October 19, 2010, 35 TexReg 9300; amended to be effective November 3, 2016, 41 TexReg 8612; amended to be effective April 26, 2018, 43 TexReg 2423; amended to be effective December 23, 2019, 44 TexReg 7988.

View Official Rule