State Law

Texas Statutes-Insurance Code-Title 8-Subtitle D-Chapter 1301-Subchapter B. Relations with Physicians or Health Care Providers

08/24/2023 Texas Section 1301.058

Economic Profiling


An insurer that conducts, uses, or relies on economic profiling to admit or terminate the participation of physicians or health care providers in a preferred provider benefit plan shall make available to a physician or health care provider on request the economic profile of that physician or health care provider, including the written criteria by which the physician or health care provider’s performance is to be measured. An economic profile must be adjusted to recognize the characteristics of a physician’s or health care provider’s practice that may account for variations from expected costs.