Oregon § 743B.255 Enrollee application for external review; when enrollee deemed to have exhausted internal appeal

Oregon Statutes

§ 743B.255 — Enrollee application for external review; when enrollee deemed to have exhausted internal appeal

Oregon § 743B.255

Vol.18

Title 56Insurance

Ch. 743BHealth Benefit Plans: Individual and Group

This text of Oregon § 743B.255 (Enrollee application for external review; when enrollee deemed to have exhausted internal appeal) is published on Counsel Stack Legal Research, covering Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Or. Rev. Stat. § 743B.255 (2026).

Text

(1)An enrollee shall apply in writing for external review of an adverse benefit determination by the insurer of a health benefit plan not later than the 180th day after receipt of the insurer’s final written decision following its grievance and internal appeal process under ORS 743B.250.

(2)An enrollee is eligible for external review only if the enrollee has exhausted the plan’s internal appeal procedures established pursuant to ORS 743B.250 or be deemed to have exhausted the plan’s internal appeal procedures. The insurer may waive the requirement of compliance with the internal appeal procedures and have a dispute referred directly to external review upon the enrollee’s consent. An enrollee is deemed to have exhausted the internal appeal procedures if the insurer fails to strictly compl

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(1) An enrollee shall apply in writing for external review of an adverse benefit determination by the insurer of a health benefit plan not later than the 180th day after receipt of the insurer’s final written decision following its grievance and internal appeal process under ORS 743B.250.
(2) An enrollee is eligible for external review only if the enrollee has exhausted the plan’s internal appeal procedures established pursuant to ORS 743B.250 or be deemed to have exhausted the plan’s internal appeal procedures. The insurer may waive the requirement of compliance with the internal appeal procedures and have a dispute referred directly to external review upon the enrollee’s consent. An enrollee is deemed to have exhausted the internal appeal procedures if the insurer fails to strictly comply with ORS 743B.250 and federal requirements for internal appeals.
(3) An enrollee who applies for external review of an adverse benefit determination shall provide complete and accurate information to the independent review organization as provided in ORS 743B.252.