(1) An enrollee shall apply in writing for external review of an adverse decision 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 internal review through its grievance and appeal process under ORS 743.804. An enrollee is eligible for external review only if the enrollee has satisfied the following requirements:
(a) The enrollee must have signed a waiver granting the independent review organization access to the medical records of the enrollee.
(b) The enrollee must have exhausted the plan’s internal grievance procedures established pursuant to ORS 743.804. The insurer may waive the requirement of compliance with the internal grievance procedures and have a dispute referred directly to external review upon the enrollee’s consent.
(2) An enrollee who applies for external review of an adverse decision shall provide complete and accurate information to the independent review organization in a timely manner. [2001 c.266 §11]Section: Previous 743.854 743.855 743.856 743.857 743.858 743.859 743.860 743.861 743.862 743.863 743.864 743.865 743.866 743.868 743.870 Next
Last modified: August 7, 2008