Statement of preauthorization.

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  • (1) An insurer who requires preauthorization or preapproval for coverage under accident and health insurance shall, beginning January 1, 2011, provide an enrollee with a statement of preauthorization if:
    • (a) the applicable CPT codes have been submitted to the insurer to determine whether a particular procedure is covered under the terms of the accident and health insurance policy;
    • (b) the enrollee has met the requirements for preauthorization of the procedure or encounter; and
    • (c) the enrollee requests a statement of preauthorization.
  • (2) A statement of preauthorization under Subsection (1) may be sent:
    • (a) by mail; or
    • (b) electronically.
  • (3) A statement of preauthorization shall include a statement that the preauthorization is:
    • (a) not a guarantee of payment by an insurer; and
    • (b) subject to the policy and contract provisions of the accident and health insurance contract.




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