ORS 743B.555
Confidential communications


(1)

As used in this section:

(a)

“Carrier” has the meaning given that term in ORS 743B.005 (Definitions).

(b)

“Communication” includes:

(A)

An explanation of benefits notice;

(B)

Information about an appointment;

(C)

A notice of an adverse benefit determination;

(D)

A carrier’s or third party administrator’s request for additional information regarding a claim;

(E)

A notice of a contested claim;

(F)

The name and address of a provider, a description of services provided and other visit information; and

(G)

Any written, oral or electronic communication described in this paragraph from a carrier or a third party administrator to a policyholder, certificate holder or enrollee that contains protected health information.

(c)

“Confidential communications request” means a request from an enrollee to a carrier or third party administrator that communications be sent directly to the enrollee and that the carrier or third party administrator refrain from sending communications concerning the enrollee to the policyholder or certificate holder.

(d)

“Protected health information” has the meaning given that term in ORS 192.556 (Definitions for ORS 192.553 to 192.581).

(2)

A carrier and a third party administrator doing business in this state:

(a)

Shall permit any enrollee to submit a confidential communications request.

(b)

Shall update an enrollee on the status of implementing a confidential communications request upon the enrollee’s inquiry.

(3)

The procedure adopted by a carrier or third party administrator for enrollees to make confidential communications requests:

(a)

Must allow enrollees to use the form described in subsection (4) of this section and may also allow enrollees to make the request by other means such as telephone or the Internet.

(b)

Shall ensure that the confidential communications request remains in effect until the enrollee revokes the request in writing or submits a new confidential communications request.

(c)

Shall ensure that the confidential communications request is acted upon and implemented by the carrier or third party administrator not later than seven days after receipt of a request by electronic means or 30 days after receipt of a request in hard copy.

(d)

May not require an enrollee to waive any right to limit disclosure under this section as a condition of eligibility for or coverage under a health benefit plan.

(e)

Must be easy to understand and to complete.

(4)

The Department of Consumer and Business Services shall work with stakeholders to develop and make available to the public a standardized form that an enrollee may submit to a carrier or third party administrator to make a confidential communications request. The department may encourage health care providers to clearly display the form and make it available to patients. At a minimum, the form must:

(a)

Inform an enrollee about the enrollee’s right to have protected health information sent to the enrollee and not disclosed to the policyholder or certificate holder;

(b)

Allow an enrollee to indicate where to redirect communications containing protected health information, including a specified mail or electronic mail address or specified telephone number;

(c)

Allow an enrollee to designate a mail or electronic mail address or telephone number for the carrier or third party administrator to contact the enrollee if additional information or clarification is necessary to process the confidential communications request; and

(d)

Include a disclaimer that it may take up to 30 days from the date of receipt for a carrier or third party administrator to process the form.

(5)

If an insurer makes an adverse benefit determination regarding a claim concerning health care provided to an enrollee who has made a confidential communications request:

(a)

The enrollee has the right to appeal the determination; and

(b)

The policyholder or certificate holder may not appeal the adverse benefit determination unless the enrollee has signed an authorization to disclose claims information relevant to the appeal.

(6)

As used in this section, “enrollee” does not include an individual who is in the custody of the Department of Corrections.

(7)

The department shall interpret this section in a manner that is consistent with federal law. [2015 c.470 §2]
Note: 743B.555 (Confidential communications) was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.

Source: Section 743B.555 — Confidential communications, https://www.­oregonlegislature.­gov/bills_laws/ors/ors743B.­html.

743B.001
Definitions
743B.003
Purposes
743B.005
Definitions
743B.010
Issuance of group health benefit plan to affiliated group of employers
743B.011
Group health benefit plans subject to provisions of specified laws
743B.012
Requirement to offer all health benefit plans to small employers
743B.013
Requirements for small employer health benefit plans
743B.020
Eligible employees and small employers
743B.100
Department’s authority to regulate market
743B.102
Certifications and disclosure of coverage
743B.103
Use of health-related information
743B.104
Coverage in group health benefit plans
743B.105
Requirements for group health benefit plans other than small employer plans
743B.109
Short term health insurance policies
743B.110
Implementation of federal laws
743B.125
Individual health benefit plans
743B.126
Carrier marketing of individual health benefit plans
743B.127
Rules for ORS 743.022, 743B.125 and 743B.126
743B.128
Exceptions to requirement to actively market all plans
743B.129
Shortening period of exclusion following discontinued offering
743B.130
Requirement to offer bronze and silver plans
743B.195
Enforcement of Newborns’ and Mothers’ Health Protection Act of 1996
743B.197
Health Care Consumer Protection Advisory Committee
743B.200
Requirements for insurers offering managed health insurance
743B.202
Requirements for insurers offering managed health or preferred provider organization insurance
743B.204
Required managed health insurance contract provision
743B.220
Requirements for insurers that require designation of participating primary care physician
743B.222
Designation of women’s health care provider as primary care provider
743B.225
Continuity of care
743B.227
Referrals to specialists
743B.250
Required notices to applicants and enrollees
743B.252
External review
743B.253
Director to contract with independent review organizations to provide external review
743B.254
Required statements regarding external reviews
743B.255
Enrollee application for external review
743B.256
Duties of independent review organizations
743B.257
Civil penalty for failure to comply by insurer that agreed to be bound by decision
743B.258
Private right of action
743B.260
Claims and appeals of adverse benefit determinations under disability income insurance policies
743B.280
Definitions for ORS 743B.280 to 743B.285
743B.281
Estimate of costs for in-network procedure or service
743B.282
Estimate of costs for out-of-network procedure or service
743B.283
Submission of methodology used to determine insurer’s allowable charges
743B.284
Alternative mechanism for disclosure of costs and charges
743B.285
Rules
743B.287
Balance billing prohibited for health care facility services
743B.290
Hospital payment of copayment or deductible for insured patient
743B.300
Disclosure of differences in replacement health insurance policies
743B.310
Rescinding coverage
743B.320
Minimum grace period
743B.321
Applicability of ORS 743B.320
743B.323
Separate notice to policyholder required before cancellation of individual or group health insurance policy for nonpayment of premium
743B.324
Rules for certain notice requirements
743B.330
Notice to policyholder required for cancellation or nonrenewal of health benefit plan
743B.340
When group health insurance policies to continue in effect upon payment of premium by insured individual
743B.341
Continuation of benefits after termination of group health insurance policy
743B.342
Continuation of benefits after injury or illness covered by workers’ compensation
743B.343
Availability of continued coverage under group policy for surviving, divorced or separated spouse 55 or older
743B.344
Procedure for obtaining continuation of coverage under ORS 743B.343
743B.345
Premium for continuation of coverage under ORS 743B.344
743B.347
Continuation of coverage under group policy upon termination of membership in group health insurance policy
743B.400
Decisions regarding health care facility length of stay, level of care and follow-up care
743B.403
Insurer prohibited practices
743B.405
Medical services contract provisions
743B.406
Vision care providers
743B.407
Naturopathic physicians
743B.420
Prior authorization requirements
743B.422
Utilization review requirements for medical services contracts to which insurer not party
743B.423
Utilization review requirements for insurers offering health benefit plan
743B.424
Applicability
743B.425
Prior authorization prohibited for first 60 days of treatment for opioid or opiate withdrawal and for post-exposure prophylactic antiretroviral drugs
743B.427
Nonquantitative treatment limitations on coverage of behavioral health conditions
743B.450
Prompt payment of claims
743B.451
Refund of paid claims
743B.452
Interest on unpaid claims
743B.453
Underpayment of claims
743B.454
Claims submitted during credentialing period
743B.458
Performance-based incentive payments for primary care
743B.460
Conditions for restricting payments to only in-network providers
743B.462
Direct payments to providers
743B.470
Medicaid not considered in coverage eligibility determination
743B.475
Guidelines for coordination of benefits
743B.500
Selling and leasing of provider panels by contracting entity
743B.501
Registration of contracting entity
743B.502
Third party contracts for leasing of provider panels
743B.503
Additional requirements for third party contracts
743B.505
Provider networks
743B.550
Disclosure of information
743B.555
Confidential communications
743B.601
Synchronization of prescription drug refills
743B.602
Step therapy
743B.800
Risk adjustment procedures
743B.810
Enrollees covered by workers’ compensation
Green check means up to date. Up to date