ORS 743B.555 Confidential Communications

• Library: Oregon Statutes
• Edition: 2023
• Currency: Current through legislation effective January 1, 2024
• Year: 2023
• Citation: ORS 743B.555

(1) As used in this section:

(a) "Carrier" has the meaning given that term in ORS 743B.005.

(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.

(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.