Sec. 1467.055. CONDUCT OF MEDIATION; CONFIDENTIALITY. (a) A mediator may not impose the mediator's judgment on a party about an issue that is a subject of the mediation.
(b) A mediation session is under the control of the mediator.
(c) Except as provided by this chapter, the mediator must hold in strict confidence all information provided to the mediator by a party and all communications of the mediator with a party.
(d) If the enrollee is participating in the mediation in person, at the beginning of the mediation the mediator shall inform the enrollee that if the enrollee is not satisfied with the mediated agreement, the enrollee may file a complaint with:
(1) the Texas Medical Board against the facility-based physician for improper billing; and
(2) the department for unfair claim settlement practices.
(e) A party must have an opportunity during the mediation to speak and state the party's position.
(f) Except on the agreement of the participating parties, a mediation may not last more than four hours.
(g) Except at the request of an enrollee, a mediation shall be held not later than the 180th day after the date of the request for mediation.
(h) On receipt of notice from the department that an enrollee has made a request for mediation that meets the requirements of this chapter, the facility-based physician may not pursue any collection effort against the enrollee who has requested mediation for amounts other than copayments, deductibles, and coinsurance before the earlier of:
(1) the date the mediation is completed; or
(2) the date the request to mediate is withdrawn.
(i) A service provided by a facility-based physician may not be summarily disallowed. This subsection does not require an insurer or administrator to pay for an uncovered service.
(j) A mediator may not testify in a proceeding, other than a proceeding to enforce this chapter, related to the mediation agreement.
Added by Acts 2009, 81st Leg., R.S., Ch. 1290 (H.B. 2256), Sec. 1, eff. June 19, 2009.
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