Section 350.1419 - Private Insurance(a) The contractor must obtain written parental consent to bill and to release personally identifiable information to private insurance.(b) The contractor must obtain written parental consent when initially seeking to use their private insurance and each time there is an increase (in frequency, length, duration, or intensity) in the provision of services in the IFSP that requires the contractor to obtain written parental consent.(c) If private insurance denies payment of the claim, the contractor must bill the family up to their maximum charge, based on their placement on the sliding fee scale.(d) The contractor must adjust the amount billed to the family if the contractor or parent successfully disputes a denied claim.(e) The contractor must not deny or delay a child's services if: (1) the family does not have private insurance; or(2) the parent does not give consent to bill or to release personally identifiable information to their private insurance. If the parent does not give consent, the contractor bills the family up to their maximum charge, based on their placement on the sliding fee scale.(f) A family with private insurance will not be charged disproportionately more than a family without private insurance.(g) If a child is covered by private insurance only, once the contractor has verified that the private insurance plan will not pay for certain Early Childhood Intervention (ECI) services for a child, the contractor is not required to continue to bill the private insurance plan for those services for that child. The contractor must continue to bill for any services that the private insurance company does cover. The contractor must verify coverage for ECI services with the private insurance plan at least annually.26 Tex. Admin. Code § 350.1419
The provisions of this §108.1419 adopted to be effective May 1, 2014, 39 TexReg 3449; entire chapter transferred from Title 40, Part 2, Chapter 208 by Texas Register, Volume 46, Number 06, February 5, 2021, TexReg 0941, eff. 3/1/2021; Amended by Texas Register, Volume 47, Number 10, March 11, 2022, TexReg 1290, eff. 3/17/2022