OAR 836-053-1409: Definitions

(1) As used in ORS 743B.281 and 743B.282, “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 743B.282, 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.