Oregon HB 2610 (ORS 743B.450), effective January 1, 2020, protects patients from balance billing for emergency services and scheduled non-emergency services provided by out-of-network providers at in-network facilities. Patients pay only in-network cost-sharing amounts.
Overview
Oregon's state balance billing law predates the federal No Surprises Act and covers both state-regulated insurance plans and ERISA plans. When a patient receives care from an out-of-network (OON) provider at an in-network facility for a covered service, the patient's financial responsibility is limited to the in-network deductible, copay, and coinsurance. The OON provider must bill the insurer and cannot collect the difference between the OON charge and the in-network rate from the patient.
The federal No Surprises Act (effective January 1, 2022) provides additional protections for ERISA self-funded plans not covered by Oregon state law, creating a coordinated federal-state system.
Key Requirements
- Emergency services: Patients pay in-network cost-sharing only, regardless of provider network status or facility type.
- Scheduled non-emergency services: At in-network facilities, OON providers must accept in-network rates and cannot balance bill the patient.
- In-network deductible/coinsurance applies: Patients are responsible for their normal cost-sharing (deductible, copay, coinsurance) calculated at the in-network rate.
- OON provider billing: The OON provider bills the insurer at the in-network rate and may not bill the patient for the difference.
- Written consent exception: OON providers may balance bill only if the patient provides 72-hour advance written consent acknowledging the OON status and higher costs.
Penalties and Enforcement
Oregon Division of Financial Regulation (DFR) enforces ORS 743B.450 for state-regulated plans. CMS enforces the federal No Surprises Act for ERISA plans. Violations include:
- Civil penalties assessed by the DFR.
- Denial of coverage claims and requirement to pay balance.
- Corrective action orders against insurers and providers.
- Reputational consequences and public enforcement records.
Appeals and Dispute Resolution
If a patient receives a balance bill despite protections under ORS 743B.450 or the federal No Surprises Act:
- Send a written dispute to the insurer stating the service type, facility network status, and applicable law (ORS 743B.450 or NSA).
- Request the insurer pay the OON provider at the in-network rate.
- File a complaint with the Oregon DFR (state-regulated plans) or CMS (ERISA plans) if the insurer does not adjust the claim within 30 days.
Federal Law and Coordination
The federal No Surprises Act extends balance billing protections to ERISA self-funded plans not subject to Oregon state law. When applicable, the federal rule provides the same protections: emergency care at any facility, scheduled services at in-network facilities, and the same 72-hour advance written consent requirement. The state and federal standards align closely, creating consistent protection across plan types.
Common Questions
Does Oregon's HB 2610 predate federal protections?
Yes. Oregon HB 2610 became effective January 1, 2020, approximately two years before the federal No Surprises Act took effect on January 1, 2022. Oregon patients have had state-level balance billing protections since 2020.
What enforcement options does Oregon DFR have for violations?
The Oregon DFR can impose civil penalties, require corrective payment, conduct market conduct examinations, issue cease-and-desist orders, and pursue administrative remedies against both insurers and healthcare providers violating ORS 743B.450.
Can a patient waive balance billing protections by signing a consent form?
A patient may consent in advance to OON charges, but only through a written 72-hour advance consent form that clearly states the OON status and higher costs. Blanket waivers or consent forms presented at the time of service do not override the law.
What is the difference between Oregon HB 2610 and the federal No Surprises Act?
Both laws provide similar protections, but ORS 743B.450 applies to state-regulated plans, while the federal No Surprises Act applies to ERISA self-funded plans and Medicare Advantage plans. Together, they create comprehensive coverage for Oregon patients.
Protect your revenue cycle from balance billing disputes. Altair flags network status mismatches and automates balance billing complaint management to keep your organization compliant with Oregon and federal law.
Key Statutes
- ORS 743B.450: Balance billing protections for emergency and scheduled services.
- Federal No Surprises Act (Pub. L. 116-171, effective January 1, 2022).
- 45 CFR ยง149.430-149.440: Implementing regulations for the No Surprises Act.