Bill > SB1137

This bill requires health benefit plans in Oregon to provide comprehensive coverage for autologous breast reconstruction procedures and related services, ensuring that these medical treatments are covered on par with other breast reconstruction services. The bill defines "autologous breast reconstruction procedure" broadly, including multiple specific surgical techniques like gluteal artery perforator flaps, thigh perforator flaps, and various other complex reconstructive methods. When these procedures are prescribed according to accepted medical standards by a licensed healthcare provider, health benefit plans must cover not only the primary reconstruction procedures but also all related medically necessary inpatient and outpatient services, including revisions like liposuction, grafting, nipple reconstruction, and fat necrosis excision. Additionally, the bill requires insurance carriers to maintain a network of providers sufficient to ensure timely access to these procedures, and if they cannot meet network adequacy standards, they must reimburse out-of-network providers at rates comparable to in-network reimbursement and cannot impose higher out-of-pocket costs for these services. The provisions of this bill will apply to health benefit plans issued, renewed, or extended on or after January 1, 2026, providing patients with more comprehensive and accessible breast reconstruction options.