Texas Network Adequacy Waiver Hearings: How Providers Weigh In

Texas does something few states do with network adequacy: it puts insurers' requests to skip the rules in front of the public. Since House Bill 3359 took effect on September 1, 2023, an insurer offering a preferred provider or exclusive provider plan that wants a waiver from network adequacy standards generally has to go through a public hearing, and the Texas Department of Insurance (TDI) invites providers to speak or send information. For a provider who has been told "the network is full" in a county where the insurer is asking to be excused from the standards, that hearing is the most direct forum available anywhere in commercial insurance.

What standards can an insurer ask to waive?

Insurance Code 1301.0055 directs the commissioner to adopt network adequacy standards for PPO plans that include factors on time, distance and appointment availability. Insureds must be able to get an appointment with a preferred provider within the maximum travel times and distances in 1301.00553 and 1301.00554 and within the wait times in 1301.00555 (1301.0055(b)). For a physician specialty not specifically listed, the maximum distance in any county classification is 75 miles (1301.00554(b)). The wait time standards require routine care "within three weeks for medical conditions" and "within two weeks for behavioral health conditions," and preventive care within two months for a child and three months for an adult (1301.00555).

Insurers must monitor compliance, report "any material deviation" to TDI within 30 days, and fix it no later than the 90th day unless there are no uncontracted licensed providers in the affected county or the insurer requests a waiver (1301.0055(a)(1)).

When does a waiver need a public hearing?

The commissioner "may allow a waiver for a departure from network adequacy standards for a period not to exceed one year" if, "after receiving public testimony at a public hearing under Section 1301.00565," good cause is shown (1301.0055(a)(3)). Section 1301.00565(f) is blunt: "The commissioner may not grant a waiver without a public hearing." The commissioner must set a hearing when an insurer requests a waiver that does not fit the no-uncontracted-providers exception and that the commissioner does not deny, or when an insurer does not complete corrective action for a reported material deviation (1301.00565(b)).

Waivers have limits. Generally, a plan cannot get one "more than twice consecutively for the same network adequacy standard in the same county" unless it shows "multiple good faith attempts" to comply during the prior waiver periods, or "more than a total of four times within a 21-year period for each county" for issues good faith efforts can fix (1301.0055(a)(5)). The exception is where the insurer shows, and TDI confirms annually, that "there are no uncontracted physicians or health care providers in the area" to meet the standard (1301.0055(a)(6)). That exception depends on a fact a willing, uncontracted provider can contradict.

Which factors does the commissioner weigh?

"Good faith effort" is defined: "honesty in fact, timely participation, observance of reasonable commercial standards of fair dealing, and prioritizing patients' access to in-network care" (1301.00565(a)). At the hearing the commissioner must consider all written and oral testimony and evidence, including "the total number of physicians or health care providers in each preferred provider type ... within the county and service area being submitted for the waiver and whether the insurer made a good faith effort to contract with those required preferred provider types," the facilities available and the insurer's efforts to contract with them, and population, density and geography (1301.00565(d)). The commissioner "may not consider a prohibition on balance billing" in deciding (1301.00565(e)).

How do providers take part?

The statute says the commissioner "shall notify affected physicians and health care providers that may be the subject of a discussion of good faith efforts on behalf of the insurer" and give them "an opportunity to submit evidence, including written testimony, and to attend the public hearing and offer testimony either in person or virtually" (1301.00565(c)). An out-of-network physician or hospital referenced in the insurer's request "may not be identified by name at the hearing unless the physician or hospital consents."

TDI's network adequacy waivers page explains the mechanics as of October 2026:

• Hearings are virtual and recorded; the page lists upcoming dates with links.
• To speak, submit a witness registration form; TDI "asks that forms be submitted at least two business days before the hearing."
• Written information is due "one week after the hearing date," sent to NetworkWaivers@tdi.texas.gov with "the SERFF number of the waiver request in the subject line."
• Do not include personal health information you want kept private.
• Waiver request data, including standards, specialty types and counties affected, is on the Texas Open Data Portal, and details of a single request are in SERFF Filing Access by tracking number.

Evidence that is "proprietary in nature" is generally confidential, but "Information related to provider directories, credentials, and privileges, estimates of patient populations, and actuarial estimates of needed providers" is not protected under that rule (1301.00565(g)).

What belongs in your written information?

• Who you are, your specialty, your licensed locations and the counties you serve.
• That you are uncontracted with this insurer and willing to contract, with the dates you applied or asked and the insurer's written reasons for refusing, which 1301.051(c) requires on an initial application.
• Your current availability: new-patient wait times and capacity.
• Access facts in the waiver counties: drive times from the communities you serve to the insurer's nearest preferred provider of your type, and directory listings that turned out to be wrong.
• No patient-identifying information unless the patient has authorized it.

Keep it factual. The question in front of the commissioner is whether the insurer made a good faith effort to contract with the providers who are there. A short, documented "I asked, I am here, I was refused" goes straight to that question. Our post on documenting an access gap covers the evidence in more depth.

After a waiver is granted, what follows?

TDI posts the plan name, insurer, each affected county, the standards waived and the insurer's access plan on its website, and the insurer must disclose the waiver "in all promotion and advertisement" of the plan (1301.0055(a)(3) and (4)). Waivers last no more than a year. Insurers are also examined at least every three years and in connection with these hearings (1301.0056(a-1)). Judicial review of a waiver decision is available to "a policyholder" in a Travis County district court, de novo (1301.00565(h)). The statute does not give that right to providers by name, which is one more reason to put your evidence in the record at the hearing stage. Whether any other legal avenue exists for you is a question for a healthcare attorney.

Is a waiver hearing a way to force a contract?

No. The commissioner decides whether to excuse the insurer from a standard; the hearing does not order the insurer to contract with you. What it can do is put the insurer's refusal of an available provider on the record in the one proceeding where that fact matters most, and give the insurer a reason to revisit the refusal before its next waiver request. Pair it with the rights in Texas's PPO fair opportunity law.

Our role, and yours

We research, prepare and organize; we are not a law firm and we do not speak for providers at hearings. As part of a Payer Network Dispute ($799 per payer, $1,999 for three), we monitor TDI's hearing list for your counties, pull the waiver data from the Open Data Portal and SERFF, and prepare your written information and talking points. You register, speak and send under your own name. A Network Rejection Review ($249, credited toward a dispute) comes first, and Panel Watch ($199 per year) keeps an eye on new waiver dockets and reopening dates. If the insurer later offers a contract, the win fee is a flat $1,500. See our Texas network access page for the rest of the state's rules.