Q1: What is the company's practice in handling telemedicine?
Our company's telemedicine practices follow Texas statute 1455.004:
COVERAGE FOR TELEMEDICINE MEDICAL SERVICES AND TELEHEALTH SERVICES.
(a) A health benefit plan may not exclude from coverage a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service or a telehealth service solely because the covered health care service or procedure is not provided through an in-person consultation.
(b) A health benefit plan may require a deductible, a copayment, or coinsurance for a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service or a telehealth service. The amount of the deductible, copayment, or coinsurance may not exceed the amount of the deductible, copayment, or coinsurance required for the covered health care service or procedure provided through an in-person consultation.
(c) Notwithstanding Subsection (a), a health benefit plan is not required to provide coverage for a telemedicine medical service or a telehealth service provided by only synchronous or asynchronous audio interaction, including:
- An audio-only telephone consultation
- A text-only email message
- A facsimile transmission.
Q2: I have a health plan with a utilization review requirement. Where can I locate the federal external review forms?
The federal external review forms can be downloaded from these links:
- HHS-Administered Federal External Review Request Form
- HHS Federal External Review Process Appointment of Representative (AOR) Form
Q3: Where can I locate the Texas Prior Authorization Request Form for Prescription Drug Benefits?
You can download the form by clicking here. Please note that the patient must be eligible and your plan must have prescription coverage to qualify for benefits.
Q4: Is there a resource that describes my PPO network? Is there an Access Plan that applies to my coverage?
Pursuant to Title 28 Texas Administrative Code § 3.3705(b), the PPO network disclosure can be accessed by selecting the link corresponding with the company with whom you are insured. Next to the company name is a second link that will provide you the company's Access Plan, as required by the state of Texas.