An insurer offering a health benefit plan that requires prior authorization for surgical procedures may not require prior authorization for an additional or related health care procedure that is identified during the authorized surgical procedure if:

1. (1) The provider, while providing an approved surgical procedure, identifies a medical condition, disease or ailment that was not identified in the prior authorization request and, in accordance with generally accepted standards of medical practice, determines that performing a related health care procedure, instead of or in addition to the approved surgical procedure, is medically necessary and, in the provider’s judgment, to interrupt or delay the provision of care in order to obtain prior authorization for the additional or related health care procedure would not be medically advisable;
2. (2) The additional or related health care procedure is a covered benefit under the enrollee’s health benefit plan; and
3. (3) The additional or related health care procedure is not experimental or for investigation purposes.

Note: 743B.430 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.

[2025 c.388 §2]