{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-7301","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-7301","heading":"Dental plan fee regulation - Appeals procedures","body":"A. No contract between a dental plan of a health benefit plan\n\nand a dentist for the provision of services to patients may require\n\nthat a dentist provide services to its subscribers at a fee set by\n\nthe health benefit plan unless the services are covered services\n\nunder the applicable subscriber agreement.\n\nB. As used in this section:\n\n1. \"Covered services\" means services reimbursable under the\n\napplicable subscriber agreement, subject to the contractual\n\nlimitations on subscriber benefits as may apply, including, for\n\nexample, deductibles, waiting period or frequency limitations;\n\n2. \"Dental plan\" means and shall include any policy of\n\ninsurance which is issued by a health benefit plan which provides\n\nfor coverage of dental services not in connection with a medical\n\nplan; and\n\n3. \"Health benefit plan\" means any plan or arrangement as\n\ndefined in subsection C of Section 6060.4 of this title or any\n\ndental service corporation authorized pursuant to Section 2671 of\n\nthis title.\n\nC. A health benefit plan or dental plan shall establish and\n\nmaintain appeal procedures for any claim by a dentist or a\n\nsubscriber that is denied based on lack of medical necessity. Any\n\nsuch denial shall be based upon a determination by a dentist who\n\nholds a nonrestricted license in the United States. Any written\n\ncommunication to a dentist that includes or pertains to a denial of\n\nbenefits for all or part of a claim on the basis of a lack of\n\nmedical necessity shall include the identifier and license number\n\ntogether with state of issuance, and a contact telephone number of\n\nthe licensed dentist making the adverse determination. The dentist\n\nwho reviewed the claim shall only be contacted at the telephone\n\nnumber provided in the written communication about the denial during\n\nbusiness hours.","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":"896aa38ba8b98e8aeba7f6b9510419104e42e976dba8744b2d5043d0f2659d01","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-7204","next":"us-ok/okla.-stat.-tit.-36-36-7302"},"notice":"GroundRules: Original legal text. Not legal advice."}