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

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

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.

Oklahoma Statutes - Title 36. Insurance

C. If a health care provider deems it necessary that an insured

receive covered durable medical equipment or supplies within twentyfour (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-ofnetwork 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.

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.