(a) Each contract under a preferred provider benefit plan between an insurer and a physician or other practitioner or a physicians’ group must have a mechanism for resolving complaints initiated by an insured, a physician or other practitioner, or a physicians’ group.
(b) A complaint resolution mechanism must provide for reasonable due process that includes, in an advisory role only, a review panel selected in the manner described by § 1301.053(b).

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Terms Used In Texas Insurance Code 1301.055

  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Contract: A legal written agreement that becomes binding when signed.