Oklahoma § 36-6973 - Reimbursements — Charges — Pricing — Incentivization

§ 36-6973. Reimbursements — Charges — Pricing — Incentivization

A. No agreement between an insurer or prepaid vision plan and a

vision care provider may require that a provider provide services or

materials at a fee limited or set by the insurer or prepaid vision

plan, unless the services or materials are reimbursed as covered

services or covered materials under the contract.

B. A provider shall not charge more for services and materials

that are not covered services or materials to an enrollee of a

prepaid vision plan or insurer than his or her usual and customary

rate for those services and materials.

C. Reimbursements paid by an insurer or prepaid vision plan for

covered services and covered materials, regardless of the supplier

or optical lab used to obtain materials, shall be at the usual,

customary, and reasonable rate and made available to the vision care

provider prior to the provider accepting a contract from the insurer

or prepaid vision plan. An insurer or prepaid vision plan shall not

provide nominal reimbursement or advertise services and materials to

be covered with additional copay or coinsurance in order to claim

that services and materials are covered services and materials if

the health benefit plan or prepaid vision plan does not reimburse

for the services or materials.

D. Prepaid vision plans shall not in any manner impact the

pricing of noncovered services or materials.

E. Prepaid vision plans shall provide standard reimbursements

for all lenses with the same design, quality, and composition. The

period of time prescribed by a contract between any prepaid vision

plan and a provider for the plan to recover any reimbursement amount

from a provider shall be the same period of time allowed or required

for any provider to recover any reimbursement amount from a prepaid

vision plan.

F. A prepaid vision plan shall not use extrapolation to

complete an audit of a vision care provider. Any additional payment

due to a provider or any refund to a prepaid vision plan shall be

based on actual overpayment or underpayment and shall not be based

on extrapolation.

Oklahoma Statutes - Title 36. Insurance

G. A prepaid vision plan shall not incentivize patients to

receive vision care services at an entity owned wholly or in part by

the plan or subsidiaries of the plan. Any entity providing vision

care services shall provide notice to patients that an entity is

owned wholly or in part by the plan or subsidiaries of the plan.

H. No person or entity shall sell, solicit, or negotiate any

prepaid vision plan to an enrollee in this state without an approved

certificate of authority under Section 7 of this act.

Added by Laws 2024, c. 360, § 2, emerg. eff. May 30, 2024.