(2) Each contract between a health care service contractor and a provider of health care services shall provide that if the health care service contractor fails to pay for covered health care services as set forth in the subscriber’s evidence of coverage or contract, the subscriber is not liable to the provider for any amounts owed by the health care service contractor.
(3) If the contract between the contracting provider and the health care service contractor has not been reduced to writing or fails to contain the provisions required by subsection (2) of this section, the subscriber is not liable to the contracting provider for any amounts owed by the health care service contractor.
(4) No contracting provider or agent, trustee or assignee of the contracting provider may maintain a civil action against a subscriber to collect any amounts owed by the health care service contractor for which the subscriber is not liable to the contracting provider under this section.
(5) Nothing in this section impairs the right of a provider to charge, collect from, attempt to collect from or maintain a civil action against a subscriber for any of the following:
(a) Deductible, copayment or coinsurance amounts.
(b) Health care services not covered by the health care service contractor.
(c) Health care services rendered after the termination of the contract between the health care service contractor and the provider, unless the health care services were rendered during the confinement in an inpatient facility and the confinement began prior to the date of termination or unless the provider has assumed post-termination treatment obligations under the contract.
(6) Nothing in this section prohibits a subscriber from seeking noncovered health care services from a provider and accepting financial responsibility for these services.
(7) No health care service contractor shall limit the right of a provider of health care services to contract with the patient for payment of services not within the scope of the coverage offered by the health care service contractor. [1989 c.783 §3]
Structure 2021 Oregon Revised Statutes
Volume : 18 - Financial Institutions, Insurance
Section 750.005 - Definitions.
Section 750.015 - Management to include representatives of public.
Section 750.035 - Regulation of hospital care associations under prior law; exceptions.
Section 750.045 - Required capitalization; bond, security or letter of credit; exemptions.
Section 750.055 - Other provisions applicable to health care service contractors; rules.
Section 750.085 - Offer of replacement coverage upon order of liquidation; procedure; rules.
Section 750.095 - Requirements of contract between provider and subscriber; content.
Section 750.301 - Definitions for ORS 750.301 to 750.341.
Section 750.303 - Conditions for use of multiple employer welfare arrangement; permitted coverage.
Section 750.305 - Application for certificate.
Section 750.307 - Requirements for association or group.
Section 750.309 - Requirements for trust.
Section 750.311 - Multiple employer welfare arrangements established in another state.
Section 750.313 - Issuance or refusal of certificate of multiple employer welfare arrangement.
Section 750.315 - Maintenance of reserves; actuarial opinion; rules.
Section 750.317 - Board of trustees.
Section 750.318 - Officers and persons appointed to act on behalf of board; bond.
Section 750.319 - Salaries; other compensation.
Section 750.321 - Assessment; maintenance of capital and surplus.
Section 750.323 - Notice of coverage under plan.
Section 750.325 - Filings by trust.
Section 750.327 - Examinations.
Section 750.331 - Prohibited activities for trustee or officer.
Section 750.333 - Applicable provisions of Insurance Code; rules.
Section 750.335 - Delinquency proceedings.
Section 750.339 - Liability of excess loss insurer.
Section 750.505 - Definitions for ORS 750.505 to 750.715.
Section 750.525 - Inapplicability of ORS 750.505 to 750.715 to certain legal services.
Section 750.535 - Registration requirements.
Section 750.545 - Application; fee.
Section 750.555 - Issuance of certificate of registration.
Section 750.565 - Duration of certificate; renewal; fee.
Section 750.585 - Written provider agreement with providing attorney.
Section 750.595 - Membership agreement.
Section 750.635 - Registered agent and registered office in state required.
Section 750.685 - Indemnification insurance or bond required.