| (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.
|
| Source Note: The provisions of this §350.1419 adopted to be effective May 1, 2014, 39 TexReg 3449; transferred effective March 1, 2021, as published in the Texas Register February 5, 2021, 46 TexReg 941; amended to be effective March 17, 2022, 47 TexReg 1277 |
