28 Tex. Admin. Code § 10.85 - Selection of Treating Doctor; Change of Treating Doctor
(a) Selection of treating doctor. An injured
employee who lives within the service area is entitled to the employee's
initial choice of a treating doctor from the list provided by the network of
all treating doctors under contract with the network who provide services
within the service area in which the injured employee lives in accordance with
Insurance Code §
1305.104(a),
concerning Selection of Treating Doctor.
(b) Change of treating doctor. An injured
employee who is dissatisfied with the employee's initial choice of treating
doctor or with an alternate treating doctor may select an alternate or
subsequent treating doctor in accordance with Insurance Code §
1305.104(b) -
(e).
(c) Use of specialist as treating doctor. An
injured employee with a chronic, life-threatening injury or chronic pain
related to a compensable injury may apply to the network's medical director to
use a specialist that is in the same network as the injured employee's treating
doctor in accordance with Insurance Code §
1305.104(f) -
(i).
(d) Request for an HMO primary care physician
or provider as the employee's treating doctor. An injured employee required to
receive health care services within a network may select as the employee's
treating doctor a doctor who the employee selected, prior to injury, as the
employee's primary care physician or provider under Chapter 843, as the terms
"physician" and "provider" are defined in that chapter. The network must grant
an employee's request for an HMO primary care physician or provider to serve as
the employee's treating doctor if the physician or provider agrees to abide by
the terms of the network's contract and comply with Insurance Code Chapter
1305, Subchapters D - I, and rules adopted under those subchapters, as
applicable to treating doctors.
Notes
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