Texas

Regulator: Texas Department of Insurance (TDI)
External review: State-run. Request it through the regulator after the plan's final internal denial; the federal floor is 4 months (45 CFR 147.136).
Published reversal rate: Not published by the regulator · source
Notes: Data gap on count fields: TDI publishes IRO decisions individually but does not publish consolidated overturn statistics. Note: KFF 2024 lists TX as HHS-administered; TDI operates state-level IRO process for workers' compensation and certifies IROs. Methodology divergence: TX IRO data structure differs materially from CA DMHC IMR; not directly comparable.

Before external review

File the plan's internal appeal first (at least 180 days for ACA-compliant plans; the letter states the date). Ask for the claim file and the criteria the plan applied; both are free on request. Self-funded employer plans use the federal external review and the U.S. Department of Labor, not the state.

More on Texas: state appeal rights · External Review Index entry · insurer denial rates (HealthCare.gov states).

Verified 2026-09-15. The regulator's site and your denial notice control.