Board of Chiropractic Examiners, Chapter 811
Rule Caption: Amend Pre-paid treatment plans rule
Adm. Order No.: BCE 2-2013
Filed with Sec. of State: 8-2-2013
Certified to be Effective: 8-2-13
Notice Publication Date: 7-1-2013
Rules Amended: 811-015-0002
Subject: More explicit language was needed for refund provisions when care is terminated pre-paid plans.
Rules Coordinator: Kelly J. Beringer—(503) 373-1573
Pre-Paid and Contracted Treatment Plans
A Pre-Paid Plan is a package of services and/or products that are purchased by patients at a reduced or discounted cost than if the services were purchased individually.
(1) Chiropractic physicians may accept pre-payment for services planned but not yet delivered only if they do so in such a way that it does not constitute the practice of insurance.
(a) “Insurance” is defined as a contract whereby one undertakes to indemnify another or pay or allow a specified or ascertainable amount or benefit upon determinable risk contingencies (ORS 731.102).
(b) Chiropractic physicians or clinics who are certified by the Oregon Department of Insurance as Medical Retainer Plans are exempted from this section.
(c) These plans must not be in violation of OAR 811-015-0000 (Fees).
(2) Pre-Paid and Contracted Treatment Plans must include the following, in writing:
(a) The total costs/fees that the patient will incur and the method and timing of payment(s).
(b) Description of what services and products are included and excluded — If nutritional products or other hard goods including braces, supports or patient aids are to be used during the proposed treatment plan, the patient documents must state whether these items are included in the gross treatment costs or if they constitute a separate and distinct service and fee. Any additional fees must be explained to the patient in advance and noted in the chart notes.
(c) Description of the time frame which the plan covers.
(d) How special circumstances, such as extended absences, new injury or illness are handled.
(e) Statement that there is no claim or representation of a guarantee of results, outcome, or the cure of a particular condition.
(3) Early Termination of Care:
(a) The pre-payment plan must include a written explanation on how the unused portion of funds are calculated or prorated should the patient complete care early or discontinue care due to the patient’s choice, doctor’s choice, moving, or new injury, or condition. The written explanation must be clearly labeled “Refund Policy” and explained in plain language that is understood by the patient. The explanation must include a table of calculations that illustrates the amount of refunds or amount owed in the event of the pre-paid plan’s early termination.
(b) The patient may have the right to terminate the Pre-Pay Plan at any time: In event of early termination of a pre-paid treatment plan by the patient, the maximum fee charged cannot exceed the chiropractor’s usual and customary fee cash pay (including any time of service discount) for the services rendered.
(c) The chiropractic physician may terminate the Pre-Pay Plan at any time, for good and sufficient cause, except licensee must ensure that patient abandonment does not occur. In event of early termination of a pre-paid treatment plan by the chiropractic physician or clinic, the maximum fee charged cannot exceed pro-rated fees as agreed upon in the pre-paid treatment plan.
(4) Pre-Pay Plans must be in compliance with all other applicable State or Federal Laws.
Stat. Auth.: ORS 684
Hist.: BCE 3-2010, f. & cert. ef. 6-15-10; BCE 2-2013, f. & cert. ef. 8-2-13
Oregon Secretary of State • 136 State Capitol • Salem, OR 97310-0722
Phone: (503) 986-1523 • Fax: (503) 986-1616 • firstname.lastname@example.org
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