{"data":{"id":"us-ok/okla.-stat.-tit.-63-63-2550.2","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 63, § 63-2550.2","heading":"Referral to and treatment by specialist","body":"A. A managed care plan that has no participating provider for a\n\ncovered benefit requiring a specialist shall arrange for a referral\n\nto a specialist with expertise in treating the covered benefit. The\n\nspecialist shall agree to abide by the terms of the plan’s provider\n\ncontract if the terms are commensurate with the terms of contracts\n\nfor similar specialists.\n\nB. 1. A managed care plan shall include procedures by which a\n\ncovered person in a managed care plan, upon diagnosis by a primary\n\ncare provider of a condition that without specialized treatment\n\nwould result in deleterious outcomes that would threaten life or\n\nlimb or a degenerative and disabling condition or disease, either of\n\nwhich requires specialized medical care over a prolonged period of\n\ntime, may be referred to a specialist with expertise in treating\n\nsuch condition or disease.\n\n2. The specialist may be responsible for and may provide and\n\ncoordinate the covered person’s primary and specialty care only if\n\nthe specialist is willing to abide by the terms of the plan’s\n\ncontract and capable of providing such care.\n\n3. If the managed care plan, or the primary care provider in\n\nconsultation with the managed care plan and the specialist, if any,\n\ndetermines that the most appropriate coordinator of the covered\n\nperson’s care is a specialist, the managed care plan shall authorize\n\na referral of the covered person to the specialist. In no event\n\nshall a managed care plan be required to permit a covered person to\n\nelect treatment by a nonparticipating specialist, except pursuant to\n\nthe provisions of subsection A of this section.\n\nC. 1. A referral pursuant to this section shall be pursuant to\n\na treatment plan agreed to by the managed care plan, the specialist\n\nand the primary care provider which complies with the covered\n\nbenefits of the health plan and which is developed in consultation\n\nwith the primary care provider, if appropriate, the specialist, and\n\nthe covered person or the designee of the covered person.\n\n2. Subject to the terms of the treatment plan agreed to by the\n\nmanaged care plan, the specialist and the primary care provider and\n\nsubject to the terms of the plan’s contract, a specialist shall be\n\npermitted to treat the covered person without a referral from the\n\ncovered person’s primary care provider and may authorize referrals,\n\nprocedures, tests and other medical services as the covered person’s\n\nprimary care provider would otherwise be permitted to provide or\n\nauthorize.\n\n3. If a managed care plan refers a covered person to a\n\nnonparticipating specialist, services provided pursuant to the\n\ntreatment plan shall be provided pursuant to the provisions of\n\nsubsection A of this section at no additional cost to the covered\n\nperson beyond what the covered person would otherwise pay for\n\nservices received within the network of the managed care plan.\n\nD. A managed care plan shall implement procedures for a\n\nstanding referral to a specialist if the primary care provider\n\ndetermines in consultation with the specialist and the managed care\n\nplan that a covered person needs continuing care from a specialist.\n\nThe referral shall be made pursuant to a treatment plan that\n\ncomplies with covered benefits of the managed care plan.","path":["OK Code","Title 63"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os63.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"a71b506233c97d033e74f2a73d126428ebdea2d47a1646dee580b3a6179a7519","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-63-63-2550.1","next":"us-ok/okla.-stat.-tit.-63-63-2550.3"},"notice":"GroundRules: Original legal text. Not legal advice."}