{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6571","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6571","heading":"Determination of average area or customary and reasonable","body":"charges - Disclosure to health care provider of information used.\n\nA. As used in this section:\n\n1. \"Health care provider\" means any person, firm, corporation\n\nor other legal entity that is licensed, certified or otherwise\n\nauthorized by the laws of this state to provide health care\n\nservices, procedures or supplies in the ordinary course of business\n\nor practice of a profession; and\n\n2. \"Insurer\" means any insurance company, not-for-profit\n\nhospital service and medical indemnity plan, health insurance\n\nservice organization, preferred provider organization or other\n\nentity offering health insurance policies, contracts or benefits in\n\nthis state.\n\nB. Any insurer which:\n\n1. Makes a determination or contracts with a third party who\n\nmakes the determination of average area charges or customary and\n\nreasonable charges for health care services, procedures or supplies;\n\nand\n\n2. Based on such determination, authorizes payment in an amount\n\nwhich is less than the amount charged by the health care provider\n\nfor such services, procedures or supplies;\n\nshall, upon the request of a health care provider, furnish the name,\n\nmailing address and telephone number of the party making the\n\ndetermination to the health care provider.\n\nC. Upon the request of the health care provider, the party\n\nshall furnish, for a reasonable charge, information used to\n\ndetermine the average area charges or customary and reasonable\n\ncharges for the services, procedures or supplies provided by the\n\nhealth care provider and authorized for payment pursuant to\n\nparagraph 2 of subsection B of this section. The information shall\n\ninclude the rationale and documentation of sources used in the\n\ndetermination of the average area charges or customary and\n\nreasonable charges for the services, procedures or supplies in\n\nquestion, including names, mailing addresses and telephone numbers\n\nof sources if available. Such information shall be furnished to the\n\nhealth care provider no later than ten (10) working days after the\n\nrequest for information by the health care provider.\n\nD. 1. No insurer shall use the services of a party for the\n\ndetermination of average area charges or customary and reasonable\n\ncharges which is not in compliance with the provisions of this\n\nsection.\n\n2. Noncompliance shall be reported to the Insurance\n\nCommissioner who, upon investigation of the complaint and\n\ndetermination that the party is in noncompliance and that no\n\nresolution of the complaint will be made within a reasonable time,\n\nshall compile and maintain a list of parties which are not in\n\ncompliance with the provisions of this section.","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":"2443cf93b2f1e48e0ad5d0b8640f70fd311c4da7e18be8b273f2109b8b1013cf","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6570.9","next":"us-ok/okla.-stat.-tit.-36-36-6581"},"notice":"GroundRules: Original legal text. Not legal advice."}