Tex. Insurance Code § 566.051
This is the official text of Tex. Insurance Code § 566.051, part of Texas’s Insurance Code — regulates insurance companies and the policies they sell.
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§ 566.051. LIMITATIONS ON BILLING; NOTICE.
Official statutory text
(a) A nonparticipating supplier may not charge an enrollee more than 115 percent of the Medicare-approved amount for durable medical equipment, orthotic devices or supplies, or prosthetic devices or supplies covered under Medicare for which the supplier has not accepted written assignment unless:
(1) before the enrollee is billed, the enrollee agrees in writing to pay the additional amount; and
(2) before receiving the durable medical equipment, orthotic device or supply, or prosthetic device or supply, the enrollee:
(A) enters into a rental payment plan; or
(B) pays the additional amount in full.
(b) A written agreement between a nonparticipating supplier and enrollee under this section must provide notice to the enrollee that:
(1) Medicare will reimburse 80 percent of the Medicare-approved amount for durable medical equipment, orthotic devices or supplies, or prosthetic devices or supplies covered under Medicare; and
(2) a Medicare supplement benefit plan issuer is not required to reimburse the nonparticipating supplier or enrollee for the amount by which the charge exceeds 115 percent of the Medicare-approved amount.
(1) before the enrollee is billed, the enrollee agrees in writing to pay the additional amount; and
(2) before receiving the durable medical equipment, orthotic device or supply, or prosthetic device or supply, the enrollee:
(A) enters into a rental payment plan; or
(B) pays the additional amount in full.
(b) A written agreement between a nonparticipating supplier and enrollee under this section must provide notice to the enrollee that:
(1) Medicare will reimburse 80 percent of the Medicare-approved amount for durable medical equipment, orthotic devices or supplies, or prosthetic devices or supplies covered under Medicare; and
(2) a Medicare supplement benefit plan issuer is not required to reimburse the nonparticipating supplier or enrollee for the amount by which the charge exceeds 115 percent of the Medicare-approved amount.
Status: in_force · Read it on the official government site
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