{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6060.52","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6060.52","heading":"Choice to pay out of pocket — Documentation to carrier","body":"— Deductible and out of pocket apportionment.\n\nA. An enrollee may choose to pay out of pocket for a health\n\ncare service from a health care provider. If an enrollee obtains a\n\nmedically necessary health care service covered by his or her health\n\nbenefit plan and negotiates for a price lower than the average\n\nallowed amount established by the benefit plan and provided to the\n\nenrollee upon request, and the enrollee pays out of pocket for the\n\nhealth care service, the enrollee may electronically send\n\ndocumentation to the carrier that provides the following:\n\n1. The health care service the enrollee or patient received and\n\nthe name of the health care provider and contact information;\n\n2. If an order by the health care provider is required by the\n\npolicy, the order from the health care provider given to the\n\nenrollee or patient and the final bill or statement for the health\n\ncare service; and\n\n3. The negotiated cost of the health care service that the\n\nenrollee received and that:\n\na. the enrollee paid out of pocket for the health care\n\nservices received, and\n\nb. the health care entity is not making a claim against\n\nthe carrier for payment for the health care service\n\nprovided to the enrollee or patient.\n\nB. The health care provider shall accept the payment from the\n\nenrollee as payment in full and shall not bill the enrollee or the\n\nhealth benefit plan for any balance between the amount collected\n\nfrom the enrollee and the billed charge for the service by the\n\nprovider.\n\nC. A carrier that receives the documentation described in\n\nsubsection A of this section shall count the full amount that the\n\nenrollee paid out of pocket toward the deductible and annual maximum\n\nout-of-pocket expense if:\n\n1. The health care service is covered under the health benefit\n\nplan of the enrollee; and\n\n2. The enrollee negotiated for a lower cost for the health care\n\nservice than the average allowed amount established by his or her\n\nhealth benefit plan for that covered health care service.\n\nD. The amount of the out-of-pocket cost shall be attributed to\n\nthe in-network deductible and annual maximum out-of-pocket expense\n\nif the provider was an in-network provider, and to the out-of-\n\nnetwork deductible and annual maximum out-of-pocket expense if the\n\nprovider was an out-of-network provider.\n\nE. The amount counted toward an applicable out-of-pocket\n\ndeductible and annual maximum out-of-pocket expense shall not exceed\n\nthe total amount that the enrollee is required to pay out of pocket\n\nduring a contractually agreed upon period of time for health care\n\nservices that are included under the health benefit plan of the\n\nenrollee, and shall not carry over once a new contract or agreement\n\nperiod for the plan begins.","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":"0a524c240cf43c50dff900d79369b286d2b9ed6af89734f2e1ceff5e4a586f40","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6060.51","next":"us-ok/okla.-stat.-tit.-36-36-6060.5a"},"notice":"GroundRules: Original legal text. Not legal advice."}