Oklahoma § 36-6594 - Prerequisites to maintaining cause of action - Exhaustion

§ 36-6594. Prerequisites to maintaining cause of action - Exhaustion

of appeal and review process and all applicable remedies - Notice.

A. A person may not maintain a cause of action under this act

against a health insurance carrier, health maintenance organization,

or other managed care entity unless the affected enrollee or the

representative of the enrollee, has exhausted any appeal and review

process applicable under the utilization review requirements of the

plan, has exhausted all applicable remedies specified in the

Oklahoma Managed Care External Review Act and gives written notice

of the claim as provided in subsection B of this section.

B. The notice required by subsection A of this section shall be

delivered or mailed to the health insurance carrier, health

maintenance organization, or managed care entity against whom the

Oklahoma Statutes - Title 36. Insurance

action will be brought at least thirty (30) days before the action

is filed.

C. If the enrollee or the representative of the enrollee has

not exhausted the appeal and review processes and gives notice as

required by subsection A of this section before the statute of

limitations applicable to a claim against a managed care entity has

expired, the limitations period is tolled until thirty (30) days

after the date the enrollee or the representative of the enrollee

has exhausted the processes for appeal and review pursuant to

subsection A of this section.

Added by Laws 2000, c. 163, § 4, eff. July 1, 2000.