Oregon
Oregon compares like providers and requires a clear credit request.
Certain Oregon health benefit plans issued, renewed, or extended on or after January 1, 2026 may credit an eligible direct payment. Eligibility and the credit amount are determined by the insurer under the governing plan and Oregon law.
Do not reuse another state's checklist.
- The service must be medically necessary and covered by the plan. Health maintenance organization (HMO) plans are excluded.
- The member pays the provider directly and does not submit the underlying provider claim to the insurer for ordinary payment.
- The paid amount must be less than the insurer's applicable average discounted rate for the same item or service paid to a directly contracted in-network provider with the same license.
- Oregon law does not publish a universal numeric threshold, averaging method, lookback period, geographic unit, or same-license method. Do not infer one from cash prices, Medicare, APAC medians, or generic negotiated rates.
- Follow the insurer's current credit-request route and documentation requirements. The insurer may use a dedicated process or its existing claims-processing system.
Use the source this state or plan provides.
No verified public per-plan statutory comparator is available. The insurer confirms plan-specific eligibility, documentation, and credit decisions.
Browse verified cash pricesGet the price and service codes in writing.
If you are not using insurance, ask for a written Good Faith Estimate. Federal rules generally require one when you request it or schedule care at least three business days in advance. This price document is separate from the state credit process. Read the CMS guidance →
Read the rule and current instructions.
Educational information only. The plan decides whether a payment qualifies, and state-specific scope, timing, and documentation control.