Texas Workers' Compensation

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§ 134.155. Federal Military Treatment Facility Disputes

(a) Disputes over charges billed by a federal military treatment facility (FMTF):

(1) If an insurance carrier denies payment of a medical bill based on medical necessity, the medical necessity dispute shall be initiated under §133.308 of this title (concerning MDR of Medical Necessity Disputes):

(A) Notwithstanding Chapter 133, Subchapter D, of this title (concerning Dispute of Medical Bills), an injured employee is not required to request reconsideration prior to requesting medical dispute resolution;

(B) Notwithstanding §133.308(f)(2)(B), an injured employee may be a requestor in a medical necessity dispute, and

(C) Notwithstanding §133.308(q), the insurance carrier shall pay all independent review organization fees.

(2) For all other disputes, a party may request a benefit review conference as described under Chapter 141 of this title (concerning Dispute Resolution–Benefit Review Conference).

(b) Except as provided in this section, an FMTF dispute will be conducted in accordance with the division’s rules for dispute resolution in §133.308 or Chapters 140-147 of this title.

(c) In accordance with Labor Code §504.055 (relating to Expedited Provision of Medical Benefits for Certain Injuries Sustained by First Responders in Course and Scope of Employment) a request for an FMTF dispute that involves a first responder’s request for payment of medical expenses will be accelerated by the division and given priority. A first responder shall provide notice to the division that the request involves a first responder.

The provisions of this §134.155 adopted to be effective December 11, 2019, 44 TexReg 7549.

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At a Glance:

Title:

§ 134.155. Federal Military Treatment Facility Disputes

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

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