Bill Text: OR SB608 | 2013 | Regular Session | Introduced

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Bill Title: Relating to claims for health insurance reimbursement; declaring an emergency.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2013-07-08 - In committee upon adjournment. [SB608 Detail]

Download: Oregon-2013-SB608-Introduced.html

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     77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session

NOTE:  Matter within  { +  braces and plus signs + } in an
amended section is new. Matter within  { -  braces and minus
signs - } is existing law to be omitted. New sections are within
 { +  braces and plus signs + } .

LC 3271

                         Senate Bill 608

Sponsored by Senator ROBLAN

                             SUMMARY

The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.

  Requires Department of Consumer and Business Services to adopt
form and standards for enrollee to claim reimbursement of
out-of-network provider charges paid by enrollee. Requires
insurer, within 30 days of receipt, to pay claim for covered
services made by enrollee on form adopted by department.
  Declares emergency, effective on passage.

                        A BILL FOR AN ACT
Relating to claims for health insurance reimbursement; creating
  new provisions; amending ORS 743.061; and declaring an
  emergency.
Be It Enacted by the People of the State of Oregon:
  SECTION 1. ORS 743.061 is amended to read:
  743.061. (1) The Department of Consumer and Business Services
may adopt by rule uniform standards applicable to persons listed
in subsection (2) of this section for health care financial and
administrative transactions, including uniform standards for:
  (a) Eligibility inquiry and response;
  (b) Claim submission;
  (c) Payment remittance advice;
  (d) Claims payment or electronic funds transfer;
  (e) Claims status inquiry and response;
  (f) Claims attachments;
  (g) Prior authorization;
  (h) Provider credentialing; or
  (i) Health care financial and administrative transactions
identified by the stakeholder work group described in ORS
743.062.
  (2) Any uniform standards adopted under subsection (1) of this
section apply to:
  (a) Health insurers.
  (b) Prepaid managed care health services organizations as
defined in ORS 414.736.
  (c) Third party administrators.
  (d) Any person or public body that either individually or
jointly establishes a self-insurance plan, program or contract,
including but not limited to persons and public bodies that are
otherwise exempt from the Insurance Code under ORS 731.036.
  (e) Health care clearinghouses or other entities that process
or facilitate the processing of health care financial and

administrative transactions from a nonstandard format to a
standard format.
  (f) Any other person identified by the department that
processes health care financial and administrative transactions
between a health care provider and an entity described in this
subsection.
   { +  (3) The department shall adopt by rule a form and uniform
standards for an enrollee in a health benefit plan to submit a
claim to the insurer offering the health benefit plan to request
reimbursement for the billed charges of an out-of-network
provider that were paid by the enrollee for services covered by
the health benefit plan. The form shall require a narrative
description of or a recognized standard procedure code for the
services. + }
    { - (3) - }  { +  (4) + } In developing or updating any
uniform standards adopted under   { - subsection (1) - }  { +
subsection (1) or (2) + } of this section, the department shall
consider recommendations from the Oregon Health Authority under
ORS 743.062.
  SECTION 2.  { + Section 3 of this 2013 Act is added to and made
a part of the Insurance Code. + }
  SECTION 3.  { + (1) As used in this section, 'health benefit
plan' has the meaning given that term in ORS 743.730.
  (2) An insurer offering a health benefit plan shall pay a claim
for covered services not later than 30 days after the date on
which the insurer receives the claim if:
  (a) An enrollee submits to the insurer a claim requesting the
reimbursement of an out-of-network provider's billed charges that
were paid by the enrollee for covered services; and
  (b) The claim is submitted on the form and in compliance with
the standards adopted by the Department of Consumer and Business
Services under ORS 743.061 (3).
  (3) An insurer may not prohibit an enrollee in a health benefit
plan from submitting a claim directly to the insurer in
accordance with this section.
  (4) This section does not require an insurer to reimburse an
enrollee an amount that exceeds the insurer's allowable charge
for the service minus any applicable copayment or
coinsurance. + }
  SECTION 4.  { + Section 3 of this 2013 Act applies to policies
and certificates issued or renewed on or after the effective date
of the rule adopted by the Department of Consumer and Business
Services that prescribes the form of a claim under ORS 743.061
(3). + }
  SECTION 5.  { + This 2013 Act being necessary for the immediate
preservation of the public peace, health and safety, an emergency
is declared to exist, and this 2013 Act takes effect on its
passage. + }
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