Tex. Codes » Insurance Code · TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES · SUBTITLE F. PHYSICIANS AND HEALTH CARE PROVIDERS · CHAPTER 1467. OUT-OF-NETWORK CLAIM DISPUTE RESOLUTION
Texas Codes

Tex. Ins. Code § 1467.081 (2026)

Applicability Of Subchapter

✓ current as of May 2026
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Sec. 1467.081. APPLICABILITY OF SUBCHAPTER. This subchapter applies only with respect to a health benefit claim submitted by an out-of-network provider who is not a facility.

Added by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 2.15, eff. September 1, 2019.

Notes of Decisions
Cited in 5 cases (5 in the last 5 years), 2022–2024 · leading case: Aetna Life Ins. Co., Inc. v. Michael Nazarian MD Assoc. LLC (Tex. App. 2022).
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Aetna Life Ins. Co., Inc. v. Michael Nazarian MD Assoc. LLC (Tex. App. 2022). “See Tex. Ins. Code Ann. § 1467.081 . The parties engaged unsuccessfully in the statutorily-mandated informal settlement conference at which Aetna’s final offer was $2,822.”
Unitedhealthcare Ins. Co. Unitedhealthcare of Texas, Inc. v. Acs Primary Care Physicians Sw., P.A. Hill Cnty. Emergency Med. Assocs., P.A. Longhorn Emergency Med. Assocs., P.A. Cent. Texas Emergency Assocs., P.A. Emergency Assocs. of Cent. Texas, P.A. Emergency Servs. of Texas, P.A. (Tex. 2023). “Laws 3940 , 3958-3960 (SB 1264) (codified at TEX. INS. CODE §§ 1467.081- 1467.089). 3 See TEX.”
Michael Nazarian MD Assoc. LLC v. Aetna Life Ins. Co., Inc. (Tex. App. 2023). “See Tex. Ins. Code Ann. § 1467.081 . At the mandatory pre-arbitration 3 Nazarian had previously treated the Patient before.”
Molina Healthcare of Texas, Inc. v. ACS Primary Care Physicians Sw., PA & Emergency Servs. of Texas, PA (Tex. App. 2024). “; see TEX. INS. CODE §§ 1467.081–.089. An out- of-network provider or an insurance company may not file suit for an out-of-network claim until after the conclusion of the arbitration proceeding on the issue.”
Molina Healthcare of Texas, Inc. v. ACS Primary Care Physicians Sw., PA & Emergency Servs. of Texas, PA (Tex. App. 2024). “; see TEX. INS. CODE §§ 1467.081–.089. An out- of-network provider or an insurance company may not file suit for an out-of-network claim until after the conclusion of the arbitration proceeding on the issue.”
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