Oklahoma § 36-6060.52 - Choice to pay out of pocket — Documentation to carrier

§ 36-6060.52. Choice to pay out of pocket — Documentation to carrier

— Deductible and out of pocket apportionment.

A. An enrollee may choose to pay out of pocket for a health

care service from a health care provider. If an enrollee obtains a

medically necessary health care service covered by his or her health

benefit plan and negotiates for a price lower than the average

allowed amount established by the benefit plan and provided to the

enrollee upon request, and the enrollee pays out of pocket for the

health care service, the enrollee may electronically send

documentation to the carrier that provides the following:

1. The health care service the enrollee or patient received and

the name of the health care provider and contact information;

2. If an order by the health care provider is required by the

policy, the order from the health care provider given to the

enrollee or patient and the final bill or statement for the health

care service; and

3. The negotiated cost of the health care service that the

enrollee received and that:

a.

the enrollee paid out of pocket for the health care

services received, and

b.

the health care entity is not making a claim against

the carrier for payment for the health care service

provided to the enrollee or patient.

B. The health care provider shall accept the payment from the

enrollee as payment in full and shall not bill the enrollee or the

health benefit plan for any balance between the amount collected

from the enrollee and the billed charge for the service by the

provider.

C. A carrier that receives the documentation described in

subsection A of this section shall count the full amount that the

enrollee paid out of pocket toward the deductible and annual maximum

out-of-pocket expense if:

1. The health care service is covered under the health benefit

plan of the enrollee; and

2. The enrollee negotiated for a lower cost for the health care

service than the average allowed amount established by his or her

health benefit plan for that covered health care service.

D. The amount of the out-of-pocket cost shall be attributed to

the in-network deductible and annual maximum out-of-pocket expense

if the provider was an in-network provider, and to the out-ofnetwork deductible and annual maximum out-of-pocket expense if the

provider was an out-of-network provider.

E. The amount counted toward an applicable out-of-pocket

deductible and annual maximum out-of-pocket expense shall not exceed

the total amount that the enrollee is required to pay out of pocket

Oklahoma Statutes - Title 36. Insurance

during a contractually agreed upon period of time for health care

services that are included under the health benefit plan of the

enrollee, and shall not carry over once a new contract or agreement

period for the plan begins.

Added by Laws 2025, c. 131, § 2, eff. Nov. 1, 2025.