Submission and Payment of Claims

(a) An insurer shall not require the approval of the insured or enrollee parent for the submission of claims for covered services or for the appeal of a denial of any benefit by a custodial parent, a health care provider, a child over 18 years of age, or a state agency that has been assigned medical support rights.

(b) An insurer shall not refuse or fail to make payments on covered claims directly to the custodial parent, health care provider, child over 18 years of age, or state agency submitting the claim, in accordance with the terms of the policy. Nothing in this section shall require an insurer to make duplicate payments on covered claims.

Source Note: The provisions of this §21.2009 adopted to be effective May 8, 1997, 22 TexReg 3799.