The provisions of §§19.1724 and 21.2807 of this title (relating to Verification and Effect of Filing a Clean Claim) apply to a physician or provider that provides to an enrollee or insured of an HMO or preferred provider carrier:

1. (1) care related to an emergency or its attendant episode of care as required by state or federal law; or
2. (2) specialty or other medical care or health care services at the request of the HMO, preferred provider carrier, physician, or provider because the services are not reasonably available from a physician or provider who is included in the HMO's or preferred provider carrier's network.

Source Note:The provisions of this §21.2823 adopted to be effective October 5, 2003, 28 TexReg 8647.