75th OREGON LEGISLATIVE ASSEMBLY--2009 Regular Session
 
SA to SB 508
 
LC 1480/SB 508-5
 
                      SENATE AMENDMENTS TO
                         SENATE BILL 508
 
                      By COMMITTEE ON RULES
 
                             May 29
 
  On page 1 of the printed bill, line 2, after the second
semicolon insert 'and' and after '750.333' insert a period and
delete the rest of the line and line 3.
  Delete lines 5 through 19 and insert:
  '  { +  SECTION 1. + }  { + Sections 2 and 3 of this 2009 Act
are added to and made a part of the Insurance Code. + }
  '  { +  SECTION 2. + }  { + (1) As used in this section,
'refund' means the return, either directly or through an offset
to a future claim, of some or all of a payment already received
by a health care provider.
  ' (2) Except in the case of fraud or abuse of billing, and
except as provided in subsections (3) and (5) of this section, a
health insurer may not:
  ' (a) Request from a health care provider a refund of a payment
previously made to satisfy a claim unless the health insurer:
  ' (A) Requests the refund in writing within 24 months after the
date the payment was made; and
  ' (B) Specifies in the written request why the health insurer
believes the provider owes the refund.
  ' (b) Request that a contested refund be paid earlier than six
months after the health care provider receives the request.
  ' (3) A health insurer may not do the following for reasons
related to coordination of benefits with another health insurer
or entity responsible for payment of a claim:
  ' (a) Request from a health care provider a refund of a payment
previously made to satisfy a claim unless the health insurer:
  ' (A) Requests the refund in writing within 30 months after the
date the payment was made;
  ' (B) Specifies in the written request why the health insurer
believes the provider owes the refund; and
  ' (C) Includes in the written request the name and mailing
address of the other health insurer or entity that has primary
responsibility for payment of the claim.
  ' (b) Request that a contested refund be paid earlier than six
months after the provider receives the request.
  ' (4) If a health care provider fails to contest a refund
request in writing to the health insurer within 30 days after
receiving the request, the request is deemed accepted and the
provider must pay the refund within 30 days after the request is
deemed accepted. If the provider has not paid the refund within
30 days after the request is deemed accepted, the health insurer
may recover the amount through an offset to a future claim.
  ' (5) A health insurer may at any time request from a health
care provider a refund of a payment previously made to satisfy a
claim if:
  ' (a) A third party, including a government entity, is found
responsible for satisfaction of the claim as a consequence of
liability imposed by law; and
 
 
  ' (b) The health insurer is unable to recover directly from the
third party because the third party has already paid or will pay
the provider for the health care services covered by the claim.
  ' (6) If a contract between a health insurer and a health care
provider conflicts with this section, the provisions of this
section prevail. However, nothing in this section prohibits a
health care provider from choosing at any time to refund to a
health insurer any payment previously made to satisfy a claim.
  ' (7) This section neither permits nor precludes a health
insurer from recovering from a subscriber, enrollee or
beneficiary any amounts paid to a health care provider for
benefits to which the subscriber, enrollee or beneficiary was not
entitled under the terms and conditions of the health plan,
insurance policy or other benefit agreement.
  ' (8) This section does not apply to claims for health care
services provided through dental-only health insurers, through
Medicare or through Medicare supplemental plans. + }
  '  { +  SECTION 3. + }  { + (1) Except in the case of fraud and
except as provided in subsection (2) of this section, a health
care provider may not:
  ' (a) Request additional payment from a health insurer to
satisfy a claim unless the provider:
  ' (A) Requests the additional payment in writing within 24
months after the date the claim was denied or payment intended to
satisfy the claim was made; and
  ' (B) Specifies in the written request why the provider
believes the health insurer owes the additional payment.
  ' (b) Request that an additional payment be paid earlier than
six months after the health insurer receives the request.
  ' (2) A health care provider may not do the following for
reasons related to coordination of benefits with another health
insurer or entity responsible for payment of a claim:
  ' (a) Request additional payment from a health insurer to
satisfy a claim unless the provider:
  ' (A) Requests the additional payment in writing within 30
months after the date the claim was denied or payment intended to
satisfy the claim was made;
  ' (B) Specifies in the written request why the provider
believes the health insurer owes the additional payment; and
  ' (C) Includes in the written request the name and mailing
address of the other health insurer or entity that has disclaimed
responsibility for payment of the claim.
  ' (b) Request that the additional payment be paid earlier than
six months after the health insurer receives the request.
  ' (3) If a contract between a health insurer and a health care
provider conflicts with this section, the provisions of this
section prevail. However, nothing in this section prohibits a
health insurer from choosing at any time to make additional
payments to a health care provider to satisfy a claim.
  ' (4) This section does not apply to claims for health care
services provided through dental-only health insurers, through
Medicare or through Medicare supplemental plans.'. + }
  In line 20, delete '3' and insert '4'.
  In line 23, delete 'section' and insert 'sections'.
  In line 24, after '2' insert 'and 3'.
  On page 2, line 22, delete 'section 2' and insert ' sections 2
and 3'.
  On page 3, line 15, delete '4' and insert '5'.
  In line 35, delete 'section 2' and insert 'sections 2 and 3'.
  On page 4, line 11, delete '5' and insert '6'.
  In line 35, delete 'section 2' and insert 'sections 2 and 3'.
  On page 5, line 11, delete '6' and insert '7'.
  In line 25, delete 'section 2' and insert 'sections 2 and 3'.
  In line 43, delete '7' and insert '8'.
  On page 6, line 14, delete 'section 2' and insert ' sections 2
and 3'.
  In line 31, delete '8' and insert '9'.
  On page 7, line 3, delete 'section 2' and insert 'sections 2
and 3'.
  Delete lines 20 through 24 and insert:
  '  { +  SECTION 10. Sections 2 and 3 of this 2009 Act apply to
contracts entered into or renewed on or after the effective date
of this 2009 Act.'. + }
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