Oregon External Review Law Takes Effect
A new Oregon law that allows patients to request external reviews in disputes with their health plans over treatment denials took effect July 1, making Oregon the 42nd state to have such a law, the Portland Oregonian reports. Under the law, the state Department of Consumer and Business Services will contract with three or four independent organizations to conduct the reviews, and health plans will cover the cost of the reviews. The law also requires patients to exhaust internal appeals before they request external reviews. According to the Oregonian, health plans that agree to the reviews receive protection from future lawsuits; those that refuse to adhere to the decisions of independent reviewers could face fines of as much as $1 million. The new law also:
- Allows patients who receive "active treatment" from a physician who leaves their health plans to "continue seeing that doctor, at the plan's expense," for as many as 120 days.
- Orders health plans that require members to obtain referrals from primary care providers before they visit specialists to provide "standing referrals for ongoing care" and "grant a second opinion on denied referrals."
- Requires the state to develop standards to allow patients to compare the capacity of the physician and hospital networks used by health plans in the state.
