Or. Admin. Code § 836-053-1406

Current through Register Vol. 63, No. 10, October 1, 2024

Section 836-053-1406 - Definitions

(1) As used in ORS 743.874 and 743.876, "provider" means a person licensed, certified or otherwise authorized or permitted by laws of this state to administer medical or mental health services in the practice of a profession.

(2) As used in ORS 743.876, for the purpose of an insurer's procedure for providing an estimate of an enrollee's costs for a covered out-of-network procedure or service:

(a) The "allowable charge" for a covered procedure or service is the estimated amount established under the insurance policy, whether expressed as an "allowable charge," "allowable expense," "eligible fee" or other term denoting the amount on which the benefit is calculated.

(b) The "billed charge" is the estimated amount charged by a provider for performance of a procedure or service.

Or. Admin. Code § 836-053-1406

ID16-2008, f. &cert. ef. 9-24-08

Stat. Auth.: ORS 731.244 & 743.893

Stats. Implemented: ORS 743.874 & 743.876