Section 1451.157 - Extrapolation Prohibited(a) In this section: (1) "Extrapolation" means a mathematical process or technique used by a vision care plan in the audit of an optometrist or therapeutic optometrist to estimate audit results or findings for a larger batch or group of claims not reviewed by the plan. (2) "Vision care plan" means a limited-scope policy, agreement, contract, or evidence of coverage that provides coverage for eye care expenses but does not provide comprehensive medical coverage. (b) A vision care plan may not use extrapolation to complete an audit of a participating optometrist or therapeutic optometrist. Any additional payment due to a participating optometrist or therapeutic optometrist or any refund due to the vision care plan must be based on the actual overpayment or underpayment and may not be based on an extrapolation. Tex. Ins. Code § 1451.157
Added by Acts 2023, Texas Acts of the 88th Leg.- Regular Session, ch. 898,Sec. 9, eff. 9/1/2023, app. only to a contract between a managed care plan or vision care plan and an optometrist or a therapeutic optometrist entered into or renewed, or a managed care plan or vision care plan delivered, issued for delivery, or renewed, on or after January 1, 2024.