§ 36-6991 — Prohibiting refusal of coverage for durable medical

Oklahoma § 36-6991

• Jurisdiction: Oklahoma
• Title 36: Insurance

Text

equipment. A. As used in this section: 1. “Durable medical equipment” means equipment as defined pursuant to Section 375.2 of Title 59 of the Oklahoma Statutes; 2. “Health benefit plan” means a health benefit plan as defined pursuant to Section 6060.4 of Title 36 of the Oklahoma Statutes, but shall not include any health benefit plan offered by a contracted entity as defined in Section 4002.2 of Title 56 of the Oklahoma Statutes that provides coverage to members of the state Medicaid program; 3. “Health care provider” means a provider as defined pursuant to Section 6571 of Title 36 of the Oklahoma Statutes; 4. “Health maintenance organization” or “HMO” means a health maintenance organization as defined pursuant to Section 6902 of Title 36 of the Oklahoma Statutes, but shall not include any health benefit plan offered by a contracted entity as defined in Section 4002.2 of Title 56 of the Oklahoma Statutes that provides coverage to members of the state Medicaid program; and 5. “Preferred provider organization” or “PPO” means a preferred provider organization as defined pursuant to Section 6054 of Title 36 of the Oklahoma Statutes. B. No health benefit plan, HMO, PPO, or other provider network authorized to administer health care coverage in this state shall refuse coverage to an insured for durable medical equipment and supplies as prescribed by a health care provider, regardless of whether they are in-network or out-of-network, unless there is an Oklahoma-licensed in-network provider within a fifteen-mile radius of the patient’s home address that can provide in-person evaluation for durable medical equipment, supplies, and related services. C. If a health care provider deems it necessary that an insured receive covered durable medical equipment or supplies within twenty- four (24) hours, the insured shall not be subject to drop-shipped orders and may seek such equipment and supplies from any health care provider who can provide the necessary services and supplies within the requested time frame. D. When an insured utilizes an out-of-network health care provider, as described in subsection B of this section, the out-of- network provider shall be reimbursed at the same rate and benefit level for the provided services as an in-network provider for the health benefit plan, HMO, PPO, or other provider network authorized to administer health care coverage in this state.

Legislative History

Added by Laws 2024, c. 359, § 1, emerg. eff. May 30, 2024. NOTE: Editorially renumbered from § 6981 of this title to avoid duplication in numbering.