2017 ORS 743B.287¹
Balance billing prohibited for health care facility services

(1) As used in this section:

(a) “Emergency services” has the meaning given that term in ORS 743A.012 (Emergency services).

(b) “Enrollee” means:

(A) An individual who is enrolled in a health benefit plan or a covered dependent or beneficiary of the individual; or

(B) A subscriber to a health care service contract or a covered dependent or beneficiary of the subscriber.

(c) “Health benefit plan” has the meaning given that term in ORS 743B.005 (Definitions).

(d) “Health care facility” has the meaning given that term in ORS 442.015 (Definitions), excluding long term care facilities.

(e) “Health care service contractor” has the meaning given that term in ORS 750.005 (Definitions).

(f) “In-network” has the meaning given that term in ORS 743B.280 (Definitions for ORS 743B.280 to 743B.285).

(g) “Out-of-network” has the meaning given that term in ORS 743B.280 (Definitions for ORS 743B.280 to 743B.285).

(2) Except as provided in subsection (3) of this section, a provider who is an out-of-network provider for a health benefit plan or health care service contract may not bill an enrollee in the health benefit plan or health care service contract for emergency services or other inpatient or outpatient services provided at an in-network health care facility.

(3) Subsection (2) of this section does not apply:

(a) To applicable coinsurance, copayments or deductible amounts that apply to services provided by an in-network provider; or

(b) To services, other than emergency services, provided to enrollees who choose to receive services from an out-of-network provider.

(4) If an enrollee chooses to receive services from an out-of-network provider, the provider shall inform the enrollee that the enrollee will be financially responsible for coinsurance, copayments or other out-of-pocket expenses attributable to choosing an out-of-network provider. [2017 c.417 §2]

Note: 743B.287 (Balance billing prohibited for health care facility services) becomes operative March 1, 2018. See section 7, chapter 417, Oregon Laws 2017.

Note: 743B.287 (Balance billing prohibited for health care facility services) 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.

SUBSTITUTION, RESCISSION, TERMINATION AND CONTINUATION

1 Legislative Counsel Committee, CHAPTER 743B—Health Benefit Plans: Individual and Group, https://­www.­oregonlegislature.­gov/­bills_laws/­ors/­ors743B.­html (2017) (last ac­cessed Mar. 30, 2018).
 
2 OregonLaws.org contains the con­tents of Volume 21 of the ORS, inserted along­side the per­tin­ent statutes. See the preface to the ORS An­no­ta­tions for more information.
 
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent.