{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6973","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6973","heading":"Reimbursements — Charges — Pricing — Incentivization","body":"A. No agreement between an insurer or prepaid vision plan and a\n\nvision care provider may require that a provider provide services or\n\nmaterials at a fee limited or set by the insurer or prepaid vision\n\nplan, unless the services or materials are reimbursed as covered\n\nservices or covered materials under the contract.\n\nB. A provider shall not charge more for services and materials\n\nthat are not covered services or materials to an enrollee of a\n\nprepaid vision plan or insurer than his or her usual and customary\n\nrate for those services and materials.\n\nC. Reimbursements paid by an insurer or prepaid vision plan for\n\ncovered services and covered materials, regardless of the supplier\n\nor optical lab used to obtain materials, shall be at the usual,\n\ncustomary, and reasonable rate and made available to the vision care\n\nprovider prior to the provider accepting a contract from the insurer\n\nor prepaid vision plan. An insurer or prepaid vision plan shall not\n\nprovide nominal reimbursement or advertise services and materials to\n\nbe covered with additional copay or coinsurance in order to claim\n\nthat services and materials are covered services and materials if\n\nthe health benefit plan or prepaid vision plan does not reimburse\n\nfor the services or materials.\n\nD. Prepaid vision plans shall not in any manner impact the\n\npricing of noncovered services or materials.\n\nE. Prepaid vision plans shall provide standard reimbursements\n\nfor all lenses with the same design, quality, and composition. The\n\nperiod of time prescribed by a contract between any prepaid vision\n\nplan and a provider for the plan to recover any reimbursement amount\n\nfrom a provider shall be the same period of time allowed or required\n\nfor any provider to recover any reimbursement amount from a prepaid\n\nvision plan.\n\nF. A prepaid vision plan shall not use extrapolation to\n\ncomplete an audit of a vision care provider. Any additional payment\n\ndue to a provider or any refund to a prepaid vision plan shall be\n\nbased on actual overpayment or underpayment and shall not be based\n\non extrapolation.\n\nG. A prepaid vision plan shall not incentivize patients to\n\nreceive vision care services at an entity owned wholly or in part by\n\nthe plan or subsidiaries of the plan. Any entity providing vision\n\ncare services shall provide notice to patients that an entity is\n\nowned wholly or in part by the plan or subsidiaries of the plan.\n\nH. No person or entity shall sell, solicit, or negotiate any\n\nprepaid vision plan to an enrollee in this state without an approved\n\ncertificate of authority under Section 7 of this act.","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":"4d81c38ca4fb393cea343b714d18122f5e2b72b78c5dbae37c43e942c9437832","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6972","next":"us-ok/okla.-stat.-tit.-36-36-6974"},"notice":"GroundRules: Original legal text. Not legal advice."}