{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6060.11a","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6060.11a","heading":"Procedure to assist plan members in accessing out-of-","body":"network behavioral health care providers.\n\nA. For the purposes of this act:\n\n1. “Health benefit plan” means a health benefit plan as defined\n\npursuant to Section 6060.4 of Title 36 of the Oklahoma Statutes;\n\n2. “Health care provider” or “provider” means a health care\n\nprovider as defined pursuant to Section 6571 of Title 36 of the\n\nOklahoma Statutes; and\n\n3. “Timely manner” means:\n\na. for a request for a routine appointment, a provider’s\n\nreferral for services, the start of a new treatment or\n\nmedication, or other maintenance services, as\n\ndetermined by the Insurance Department, thirty (30)\n\ndays from the date that the insured requests the\n\nappointment, service, or care,\n\nb. for residential care or hospitalization, seven (7)\n\ndays from the date that the insured first attempts to\n\nreceive care, and\n\nc. for urgent, emergency, or crisis care, twenty-four\n\n(24) hours from the date and time that the insured\n\nfirst attempts to receive care.\n\nB. A health benefit plan must establish a documented procedure\n\nto assist a plan member in accessing an out-of-network behavioral\n\nhealth care provider when no in-network behavioral health care\n\nprovider is available within a timely manner.\n\nC. If the beneficiary of a health benefit plan is unable to\n\nobtain covered behavioral health services from an in-network\n\nprovider in a timely manner as defined in subsection A of this\n\nsection, including medically appropriate telehealth services, such\n\nplan shall ensure coverage of the behavioral health services from an\n\nout-of-network provider by arranging a network exception with a\n\nnegotiated rate from an out-of-network provider. Such an agreement\n\nbetween the health benefit plan and the out-of-network provider\n\nshall hold the beneficiary harmless for any amount greater than the\n\nin-network cost-sharing amount, including copayment, coinsurance,\n\nand deductible, that the beneficiary would have paid had the same\n\nservices been rendered by an in-network provider. The negotiated\n\nrate in the network exception, in addition to the beneficiary's in-\n\nnetwork cost-sharing amount, shall be accepted as payment in full\n\nfor the provided behavioral health services. In no instance shall\n\nthe beneficiary pay more than the in-network cost-sharing amount for\n\nsuch services.\n\nD. A plan shall not be held responsible if behavioral health\n\nservices are available within a timely manner, as defined in this\n\nsection, but the beneficiary chooses to schedule services outside\n\nthe timely access standard.\n\nE. A health benefit plan that makes a payment to an out-of-\n\nnetwork provider pursuant to this section shall document the details\n\nof the payment to be made available to the Department upon request\n\nnot later than twenty (20) days from the date requested.\n\nF. The Department may promulgate rules to ensure compliance\n\nwith and effectuate the provisions of this section.\n\nG. The Insurance Department shall have the authority to\n\ninvestigate when an insurer has failed to ensure coverage as\n\nrequired by this section. After the conclusion of an investigation,\n\nthe Department may use all available tools to levy fees or fines for\n\nnoncompliance.","path":["OK Code","Title 36"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os36.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"69194ec224f655d51c5103b3f3e96bda4eca88a972678b97e19576064e6e106b","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6060.11","next":"us-ok/okla.-stat.-tit.-36-36-6060.11b"},"notice":"GroundRules: Original legal text. Not legal advice."}