Health Information by State

Arizona

The following appeal procedure applies to health care plans subject to Title 20, Chapter 15, Article 2: Health Care Appeals. Please select the packet based on the company name:

Health Care Insurer Appeals Process Information for American National Insurance Company

Health Care Insurer Appeals Process Information Packet for American National Life Insurance Company of Texas

Health Care Insurer Appeals Process Information Packet for Standard Life and Accident Insurance Company

Biomarker Testing Exemptions

Pursuant to A.R.S. § 20-1376.10

Definitions

Biomarker is a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes or pharmacological responses to a specific therapeutic intervention including gene mutations or protein expression. 

Biomarker testing is the analysis of a patient's tissue, blood, or other biospecimen for the presence of a biomarker. This includes single-analyte tests, multiplex panel tests, and whole genome sequencing. 

Exception Request

Your medical plan will consider requests for exceptions from the plan wording for biomarker testing at the request from the member or the member's provider. The requested exception will need to demonstrate the medical necessity and efficacy of the requested service when compared to the plan's normal benefit. Request may be made by calling the toll-free number on your medical ID card or by email at HealthClaims@AmericanNational.com.

Arkansas

What are the pre-authorization and non-medical review requirements for Arkansas residents? What are the pre-authorization statistics?

Select this link to view the Arkansas Review Processes. Please note that these requirements apply to insured plans only. Select this link to view the Arkansas Preauthorization Statistics.

Is there a resource that describes my PPO network?

If your plan utilizes a preferred provider network, you can find more information about the network here. You can search for a provider that is a member of the network here.

Biomarker Testing Exemptions

Pursuant to A.C.A. § 23-79-2601, § 23-79-2602

Definitions

Biomarker means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention, including known gene-drug interactions for medications being considered for use or already being administered. Biomarker includes without limitation gene mutations or protein expression. 

Biomarker testing means the analysis of patient's tissue, blood, or other bio-specimen for the presences of a biomarker. Biomarker testing includes without limitation single-analyte tests, multiplex panel tests, protein expression, and whole exome, whole genome, and whole transcriptome sequencing. 

Exception Request

Your medical plan will consider requests for exceptions from the plan wording for biomarker testing at the request from the member or the member's provider. The requested exception will need to demonstrate the medical necessity and efficacy of the requested service when compared to the plan's normal benefit. Requests may be made by calling the toll-free number on your medical ID card or by email to HealthClaims@AmericanNational.com.

California

Where can I locate information specific to California residents about mental health coverage, utilization review, and the appeal process?

The appeal process relating to questions of utilization review, experimental/investigational, medical necessity, external review, and language assistance addressed here. 

California Customer Service Information

The state of California has requested that all carriers provide the following information to aid with understanding your plan. 

1. A telephone number that the insured or provider can call, during normal business hours, for assistance obtaining mental health benefits coverage information, including the extent to which benefits have been exhausted, in-network provider access information, and claims processing information. Please call toll free to our Customer Service Department: (800) 899-6520.
2. A link to prescription drug formularies or instructions on how to obtain formular information. Our company's prescription card plans do not have formularies.
3. A detailed summary description of the process by which the insurer reviews and approves, modifies, or denies requests for health care services as described in Section 10123.135. Click here for the utilization review process.
4. Lists of providers or instructions on how to obtain a provider list as required by Section 10133.1. If you have a PPO plan, you can obtain a list of participating providers by contacting the PPO. Their information is on the back of your ID card. It includes a toll-free number and the PPO website address where you can research providers or, with some PPOs, download a personal directory. You may also find a list of PPOs a the PPO websites list. The PPO websites list will take you to any PPO's website. If you need further assistance, you can call our Customer Service Department toll-free at (800) 899-6520.
5. A detailed summary of the health insurer's grievance process. The grievance process used in California can be found here.
6. A detailed description of how the insured may request continuity of care as described in Section 10133.55. Continuity of care requests may be made to our Customer Service Department toll-free at (800) 899-6520.
7. Information concerning the right, and applicable procedure, of the insured to request an independent medical review pursuant to subdivision (i) of Section 10169. Member rights and independent medical review process may be found within the grievance process. External review application and authorization to release medical information are here.
8. We have established and maintain a Language Assistance Program under California law. You can get an interpreter at no cost to talk about your health plan and discuss your claims. You may request an interpreter through our Customer Service department toll-free at (800) 899-6520.

Colorado

Your Rights and Protections Against Surprise Medical Bills

View Your Rights

Provider Networks

Preferred Health Care System (PHCS)

Connecticut

Pursuant to Section 38a-477d, our company has provided each of its insureds a plan booklet describing benefits under one of the following policy types: basic hospital expense coverage; basic medical-surgical expense coverage; and major medical expense coverage, authorized under Section 38a-469, parts 1, 2, and 4. The booklet is in an easily readable, accessible and understandable format and provides the following information:

1. Any coverage exclusions
2. Any restrictions on the use or quantity of a covered benefit, including on prescription drugs or drugs administered in a physician's office or a clinic
3. A specific description of how prescription drugs are included or excluded from any applicable deductible, including a description of other out-of-pocket expenses that apply to such drugs
4. The specific dollar amount of any copayment and the percentage of any coinsurance imposed on each covered benefit, including each covered prescription drug and information regarding and process available to consumers, and all documents necessary, to seek coverage of a non-covered outpatient prescription drug. 

Regarding explanations of benefits each consumer who is a covered individual and legally capable of consenting to the provision of covered benefits under such policy may specify the insurance carrier:

1. Not issue explanations of benefits concerning covered benefits provided to such consumer
2. Issue explanations of benefits concerning covered benefits provided to such consumer solely to such consumer; and use a method specified by such consumer to issue such explanations of benefits solely to such consumer, and provide sufficient space in the statement for such consumer to specify a mailing address or an electronic mail address for us to use to contact such consumer concerning covered benefits provided to such consumer.

Prescription coverage for plans issues pursuant to Section 38a-469, parts 1, 2, and 4:

1. Do not have a drug formulary
2. Does not require prior authorization and step therapy
3. The coinsurance, copayment, deductible, or other out-of-pocket expense applicable to such drug may be found in your plan booklet 
4. Whether such drug is covered when dispensed by a physician or clinic

If you want to find out more about your health plan, including whether specific types of health care specialists are in-network; and whether a specific health care provider or hospital is in-network, give us a call toll-free at (800) 899-6520.

Florida

If I am a provider or resident, how can I obtain a prior authorization form for a prescription or other medical service?

The state has established a standardized form for the preauthorization of prescription drugs and other medical services. You may download the instructions below and select the form for the appropriate company:

1. Instructions for completing the preauthorization form
2. Preauthorization form for American National Insurance Company
3. Preauthorization form for American National Life Insurance Company of Texas
4. Preauthorization form for Standard Life and Accident Insurance Company

Indiana

As a resident, what are my precertification requirements?

You can call Customer Service (see the number on your ID card) or check your plan booklet to determined whether your plan has a precertification requirement. If it does, the following applies:

1. All Inpatient Hospitalizations and procedures done at an Outpatient Surgery Facility must be precertified. 
2. To comply with the precertification requirements, the Covered Person must:
   1. Contact the professional review organization at the telephone number contained in the Insured's Certificate, (866) 344-6746, as soon as possible before the expense is to be incurred.
   2. Comply with the instructions on the professional review organization and submit any information or documents they require.
   3. Notify all doctors, hospitals, and other providers that this insurance contains precertification requirements and ask them to fully cooperate with the professional review organization. 
3. If the Covered Person complies with precertification requirements, and the expenses are precertified, the Company will pay Eligible Expenses subject to all terms, conditions, provisions, and exclusions described in the plan booklet.
4. If the Covered Person does not comply with the precertification requirements, or if the expenses are not precertified, a penalty may apply, which may consist of reduction of Eligible Expenses or a reduction of benefit. See your plan booklet for more detail.
5. Emergency precertification: In the event of an emergency hospital admission, precertification must be made within 48 hours after the admission, or as soon as is reasonably possible. 
6. Concurrent Review: For inpatient stays of any kind, the professional review organization will precertify a limited number of days of confinement. Additional days of inpatient confinement may later be precertified if a Covered Person receives prior approval. 
7. Precertification Does Not Guarantee Benefits: The fact that expenses are precertified does not guarantee either payment of benefits or the amount of benefits. Eligibility for and payment of benefits are subject to all the terms, conditions, provisions, and exclusions herein.

Kentucky

What are the preauthorization and internal/external review requirements for Kentucky residents?

View the Kentucky Internal and External Review Procedures. Please note that these requirements apply to insured plans only. You can also view the Kentucky Preauthorization (Precertification) Requirements. 

Louisiana

If I have a PPO plan, where can I find links to the participating hospitals in-network physicians?

There is only one PPO currently utilized in Louisiana. Please follow the link below to your respective PPO provider list. 

Notice: Health care services may be provided to you at a network health care facility by facility-based physicians who are not in your health plan. You may be responsible for payment of all or part of the fees for those out-of-network services, in addition to applicable amounts due for copayments, coinsurance, deductibles, and non-covered services. 

Specific information about in-network and out-of-network facility-based physicians can be found at the website address of your health plan or by calling the customer service telephone number of your health plan. 

MultiPlan

Biomarker Testing Exceptions

Pursuant to La. R.S. § 22:1028.5

Definitions

Biomarker means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention, including known gene-drug interactions for medication being considered for use or currently administered. A "biomarker" includes but is not limited to gene mutations characteristics of genes, or protein expression. 

Biomarker testing means the analysis of a patient's tissue, blood, or other biospecimen for the presence of a of a biomarker. "Biomarker testing" includes but is not limited to single-analyte tests, muliplex panel tests, protein expression, whole exome, whole genome, and whole transcriptome sequencing. 

Exception Request

Your medical plan will consider requests for exceptions from the plan wording for biomarker testing at the request from the member or member's provider. The requested exception will need to demonstrate the medical necessity and efficacy of the requested service when compared to the plan's normal benefit. Requests may be made by calling the toll-free number on your medical ID or by email at HealthClaims@AmericanNational.com.

Maryland

 What mental illness/substance abuse benefits am I provided in the state of Maryland?

If your plan meets the definition of a "Health Benefit Plan" as defined by Code of Maryland § 15–1301 or §15–1401 (definitions), the plan will provide at least the following benefits for the diagnosis and treatment of a mental illness, emotional disorder, drug use disorder, or alcohol use disorder:

1. Inpatient benefits for services provided in a licenses or certified facility, including hospital inpatient and residential treatment center benefits. 
2. Partial hospitalization benefits
3. Outpatient and intensive outpatient benefits, including all office visits, diagnostic evaluations, opioid treatment services, medication evaluation, management, psychological, and neuropsychological testing for diagnostic purposes.

The benefits under this section are required only for expenses arising from the treatment of mental illnesses, emotional disorders, or drug/alcohol misuse if, in the professional judgment of health care providers the condition is treatable and that the treatment is medically necessary.

The benefits required under this section:

1. Shall be provided as one set of benefits covering mental illnesses, emotional disorders, drug misuse, and alcohol misuse.
2. Shall comply with 45 C.F.R. § 146.136(a) through (d) and C.F.R. § 2590.712(a) through (d).
3. May not be delivered under managed care system
4. May not be less than 60 days for partial hospitalization.

The Paul Wellstone and Pete Deomenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.

MHPAEA originally applied to group health plans and group health insurance coverage and was amended by the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the "Affordable Care Act") to also apply to individual health insurance coverage.

You can find more information about this protection here.

You may also contact the Maryland Insurance Administration about the benefits at:

200 St. Paul Place
Suite 2700
Baltimore, MD 21202
(410) 468-2000 | 1(800) 492-6116 (toll free) | 1(800) 735-2258 (TTY)

www.mdinsurance.state.md.us/

If you have a precertification requirement, but fail to precertify, a penalty may be applied. Again, check your Schedule of Benefits or Certificate Schedule for the potential penalty. 

Massachusetts

How can I get an estimate of my cost on a proposed medical service?

Providing your estimated cost requires some detailed information. The more information you can provide up front, the quicker we can provide a response. At a minimum we will require the provider contact's name and phone number. If possible, please provide the following information as well:

• CPT (procedural) code or detailed description of service(s) being rendered
• Amount being billed for each service
• Approximately when the service will be rendered
• A brief description of the condition

Once the information is gathered, you may call Customer Service toll-free at (800) 899-5920 or email HealthClaims.Compliance@AmericanNational.com. We will respond to your request within two working days. 

Where can I view protocols and utilization review criteria?

View the Utilization Review criteria and protocol for Massachusetts.

Behavior Health Wellness Exams

As required by ALM GL chapter 175,  § 47TT, a health benefit plan defined by (i) any policy of accident and sickness insurance, as described in section 108, which provides hospital expense and surgical expense insurance will provide coverage for an annual mental health wellness examination when performed by a licensed mental health professional or primary care provider, which may be part of an annual visit. The examination shall be covered with no patient cost-sharing (no deductible, copay, or coinsurance). 

"Mental health wellness examination" is a screening or assessment that seeks to identify any behavioral or mental health needs and appropriate resources for treatment. The examination may include:

1. Observation, a behavioral health screening, education, and consultation on healthy lifestyle changes, referrals to ongoing treatment, mental health services, and other necessary supports and discussion of potential options for medication.
2. Age-appropriate screenings or observations to understand a covered person's mental health history, personal history, and mental or cognitive state and, when appropriate, relevant adult input through screenings, interviews, and questions.

Mississippi

As a resident wanting to learn more about the PPO process, do I need referrals to see a doctor and what happens if I can't find a PPO doctor?

Our company has established a product that utilizes a Preferred Provider Organization (PPO) network to offer professional health care as needed. The principle of a PPO is to bring savings to you, the consumer, by providing a higher level of coverage (coinsurance) and reduced premiums, while directing business to providers. This benefits physicians and facilities in the PPO because they get potential patients, rather than needing to advertise to draw in business. For the insurance company, our expenses decrease, allowing us to reduce the member premiums. 

Ultimately, the coverage is yours to utilize as you please. You are in the "driver's seat," steering the course of your medical care. You have the freedom to choose any medical provider in the network that is accepting new patients. You also have the ability to change medical providers to fit your need at any time. You only need to go to the PPO's website address on your ID care or call them for a list of providers. Their toll-free number is on your ID card.

When it is an emergency or a PPO provider is not available

We know that sometimes no matter how hard you try, a PPO provider is not available and you will need to see an out-of-network provider, or nonpreferred provider. In these situations, you are still covered. In the following situations, we allow services as if performed by a PPO provider:

1. Due to the emergency nature of the care
2. When no preferred provider is reasonably available within the designated service area for which the policy was issued; and when a nonpreferred provider's services were preauthorized based upon the unavailability of the preferred provider.
3. When the insured utilizes an in-network facility and the facility-related providers are not in-network (this applies to pathologist, radiologist, anesthesiologist, physical therapist, occupational therapist, respiratory therapist, or other physical medicine provider).
4. When the insured has no choice in an assistant surgeon, if the surgeon is an in-network PPO provider. In these situations, our company will pay a claim by a nonpreferred provider at the usual or customary charge for the service at the higher, preferred benefit coinsurance level, less any patient responsibility. Furthermore, when the insured provides documentation of payments made above and beyond the allowed amount, we will apply this amount to the insured's deductible and annual out-of-pocket maximum applicable to in-network services. Our company utilizes Fair Health, a nationally recognized vendor, to determine usual reasonable or customary charges. Fair Health employs generally accepted industry standards and practices for determining the customary billed charge for a service that fairly and accurately reflects market rates, including geographic differences in costs. Allowances are based on sufficient claim data to constitute a representative and statistically valid sample. Such data is updated twice per year and is no more than three years old. The methodology is consistent with nationally recognized and generally accepted bundling edits and logic.

Referrals, Discharge Planning, and Continuity of Care

Your plan is not an HMO, where either a designated Primary Care Provider (PCP) carefully coordinates care, or you have no coverage. You have the freedom to use whichever provider you choose. Likewise, you have more responsibility for your care. Your plan does not require referrals from one provider to another; you are free to choose from any of the providers in your PPO network.

Your PPO ("preferred") provider has a responsibility to work with you through the following necessary changes:

• Referrals to another provider, such as specialists, for second opinions, etc.
• Discharging from a hospital, setting up rehabilitation services or home health care.
• It may be that a PPO provider will separate from a PPO network, whether because of retirement, relocation, or other reason. When this happens, the provider has a contractual responsibility to help you transition to your next provider. In addition to these protections, we are only a toll-free phone number away. 

Nebraska

How do I get an External Review Form following an Adverse Determination that was appealed and still denied?

Download the External Review Form for Nebraska.

Nevada

Biomarker Testing Exemptions

Pursuant to Nevada Revised Statutes Annotated § 689A

Definitions

Biomarker means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention and includes, without limitation:

1. An interaction between a gene and a drug that is being used by or considered for use by the patient
2. A mutation or characteristic of a gene
3. The expression of a protein

Biomarker Testing means the analysis of the tissue, blood, or other biospecimen of a patient for the presentation of a biomarker and includes, without limitation, single-analyte tests, multiplex panel tests, whole genome, whole exome, and whole transcriptome sequencing. 

Exception Request

Your medical plan will consider requests for exceptions from the plan wording for biomarker testing at the request from the member or the member's provider. The requested exception will need to demonstrate the medical necessity and the efficacy of the requested service when compared to the plan's normal benefit. Requests may be made by calling the toll-free number on your medical ID card or by email at HealthClaims@AmericanNational.com.

New Jersey

If I am a provider in New Jersey and would like to appeal the payment amount on a claim, does the state specify a form?

The appeal process relating to questions of utilization review, experimental/investigational and medical necessity are addressed in the plan booklet. For other payment appeals the state of New Jersey enacted the Provider Independent Claims Payment Arbitration (PICPA) process, requiring use of a carrier-specific Health Care Provider Application to Appeal A Claim Determination form (DOBICAPPCAR 10/10). Company-specific Provider Independent Claim Payment Arbitration (PICP) forms are below. Please select the link that applies to the carrier:

• PICPA form for American National Insurance Company
• PICPA form for American National Life Insurance Company of Texas
• PICPA form for Standard Life and Accident Insurance Company

If I am a provider in New Jersey, how do I learn more about claim adjudication?

You can obtain additional information by emailing ADJ.Meth@AmericanNational.com.

New Mexico

The state of New Mexico has enacted legislation requiring Health Benefit Plans issued or delivered in New Mexico that provide behavioral health coverage to discontinue cost sharing, i.e., deductible, copayment, and coinsurance. The state has provided a Bulletin 2021-09 that gives information in greater detail, found here.

Biomarker Testing Exceptions

Pursuant to New Mexico Statute Annotated § 59A-22-60

Definitions

Biomarker is a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention, including known gene-drug interactions for medications being considered for us or already being administered. "Biomarker" includes without limitation gene mutations or protein expression. 

Biomarker testing is the analysis of a patient's tissue, blood, or other biospecimen for the presences of a biomarker. Biomarker testing includes without limitation single-analyte tests, multiplex panel tests, protein expression, and whole exome, whole genome, and whole transcriptome sequencing. 

Exception Request

Your medical plan will consider requests for exceptions from the plan wording for biomarker testing at the request from the member or the member's provider. The request exception will need to demonstrate the medical necessity and efficacy of the requested service when compared to the plan's normal benefit. Requests may be made by calling the toll-free number on your medical ID card or by email at HealthClaims@AmericanNational.com.

Oklahoma

Biomarker Testing Exceptions

Pursuant to 36 Oklahoma Statute § 6060.5a

Definitions

Biomarker is a biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or of a condition or disease. A biomarker may be used to see how well the body responds to a treatment for a disease or condition or for other purposes. Biomarkers shall include but are not limited to gene mutation or protein expression.

Biomarker testing is the analysis of a patient's tissue, blood, or other biospecimen for the presence of a biomarker. Biomarker testing shall include but not be limited to single-analyte tests, multiplex panel tests, gene or protein expression, and whole exome, whole genome, and whole transcriptome sequencing. 

Exception Request

Your medical plan will consider requests for exceptions from the plan wording for biomarker testing at the request from the member or the member's provider. The requested exception will need to demonstrate the medical necessity and efficacy of the requested service when compared to the plan's normal benefit. Requests may be made by calling the toll-free number on your medical ID card or by email to HealthClaims@AmericanNational.com.

Rhode Island

Does my plan have a preauthorizatrion requirement?

Not every plan has a preauthorization requirement. If there is one, you will see a notice on your ID card. You may also review your plan document to determine whether there is a requirement, please review the link below. If you continue to have questions, we are only a toll-free call away. Our toll-free number is located on your ID card.

Preauthorization requirements

Tennessee

I reside in Tennessee and would like to get more information about the appeal process and external review. Where can I locate the procedures for my state?

The appeal process relating to questions of utilization review, experimental/investigational, medical necessity, and external review are addressed in the procedures attached. Please select the link that applies to the carrier:

• American National Insurance Company appeal process and external review
• American National Life Insurance Company of Texas appeal process and external review
• Standard Life and Accident Insurance Company appeal process and external review

Does my plan have a preauthorization requirement?

Not every plan has a preauthorization requirement. If there is one, you will see a notice on your ID card. You may also review your plan document to determine whether there is a requirement, please review the link below. If you continute to have questions, we are only a toll-free call away. Our toll-free number is located on your ID card.

Preauthorization requirements

Texas

What is the company's practice in handling telemedicine?

Our company's telemedicine practices follow Texas Statute 1455.004:

COVERAGE FOR TELEMEDICINE MEDICAL SERVICES AND TELEHEALTH SERVICES

(A) A health benefit plan may not exclude from coverage for a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service or a telehealth service solely because the covered health care service or procedure is not provided through an in-person consultation. 

(B) A health benefit plan may require a deductible, copayment, or coinsurance for a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service or telehealth service. The amount of the deductible, copayment, or coinsurance may not exceed the amount of the deductible, copayment, or coinsurance required for the covered health care service or procedure provided through an in-person consultation. 

(C) Notwithstanding Subsection (A), a health benefit plan is not required to provide coverage for a telemedicine medical service provided by only synchronous or asynchronous audio interaction, including:

• An audio-only telephone consultation
• A text-only email message
• A facsimile transmission

I have a health plan with a utilization review requirement. Where can I locate the federal external review forms?

The federal extension review forms can be downloaded from these links:

1. HHS-Administered Federal External Review Request Form
2. HHS Federal External Review Process Appointment of Representative (AOR) Form

Where can I locate the Texas Prior Authorization Request Form for Prescription Drug Benefits?

You can download the form here. Please note that the patient must be eligible and your plan must have prescription coverage to qualify for benefits.

Is there a resource that describes my PPO network? Is there an Access Plan that applies to my coverage?

Pursuant to Title 28 Texas Administrative Code § 3.3705(b), the PPO network disclosure can be accessed by selecting the link corresponding with the company with whom you are insured. Next to the company name is a second link that will provide you the company's Access Plan, as required by the state of Texas. 

• American National Insurance Company | Access Plan
• American National Life Insurance Company of Texas | Access Plan
• Standard Life and Accident Insurance Company | Access Plan

You can search for a provider that is a member of the network here.

Texas requires that we display the following notice in our provider listings:

A facility-based physician or facility-based health care practitioner, such as an anesthesiologist or radiologist, may not be included in the network. Non-participating facility-based physicians and non-participating facility-based health care practitioners may balance bill the enrollee for amounts not paid by the enrollee's health benefit plan. For more information, please refer to the 1 (800) number located on your ID card. 

This document link contains a list of in-network facilities and their facility-based physicians participating in out network(s), to include radiologists, anesthesiologists, pathologists, emergency department physicians, neonatologists, and assistant surgeons. This list is updated monthly and therefore may have changed since posting to the website. Please contact the facility to confirm any facility-based physicians that may provide services to you are participating in the network(s) and accept your benefit plan prior to services being rendered. Please see the online directory search for full details regarding a facility's demographic data, including address and contact information. 

Does my plan have a preauthorization requirement?

The company is waiving all precertification requirements for residents of Texas. Services remain subject to all other plan policies and provisions. If you would like more information, please call our Customer Service department toll-free at (800) 899-6520.

EDI Requests

Pursuant to Texas Insurance Code § 1223.002, our company offers the opportunity for providers to submit and receive EDI requests using our contracted provider, Change Healthcare. The portal can be accessed here. The EDI Player ID is 74808. Using this portal you will be able to determine:

• Whether the physician's or provider's patient is covered by the issuer's health benefit plan
• The deductible, copayment, or coinsurance for which the patient is responsible

Out of Pocket Expense Credit

Pursuant to Texas Insurance Code § 1301.140, you may request to have doctor or medical provider's service credited to your annual deductible or out-of-pocket maximum under the following circumstances:

1. You have a Preferred Provider Plan
2. The service is medically necessary
3. The provider does not bill the carrier for the service
4. Include a receipt showing that you paid for the service in full up front
5. The cost of the service is less than the average discounted price for the service by a member of your PPO network

You must submit an email to HealthClaims@AmericanNational.com with these two components:

• A request to have the service applied to your deductible and/or out-of-pocket maximum
• An itemized statement showing a description of the procedure and diagnosis