§ 6060.11a. Procedure to assist plan members in accessing out-of-network behavioral health care...
Oklahoma Statutes AnnotatedTitle 36. InsuranceEffective: November 1, 2023
Effective: November 1, 2023
36 Okl.St.Ann. § 6060.11a
§ 6060.11a. Procedure to assist plan members in accessing out-of-network behavioral health care providers
C. If the beneficiary of a health benefit plan is unable to obtain covered behavioral health services from an in-network provider in a timely manner as defined in subsection A of this section, including medically appropriate telehealth services, such plan shall ensure coverage of the behavioral health services from an out-of-network provider by arranging a network exception with a negotiated rate from an out-of-network provider. Such an agreement between the health benefit plan and the out-of-network provider shall hold the beneficiary harmless for any amount greater than the in-network cost-sharing amount, including copayment, coinsurance, and deductible, that the beneficiary would have paid had the same services been rendered by an in-network provider. The negotiated rate in the network exception, in addition to the beneficiary's in-network cost-sharing amount, shall be accepted as payment in full for the provided behavioral health services. In no instance shall the beneficiary pay more than the in-network cost-sharing amount for such services.
Credits
Laws 2023, c. 284, § 1, eff. Nov. 1, 2023.
36 Okl. St. Ann. § 6060.11a, OK ST T. 36 § 6060.11a
Current with emergency effective legislation through Chapter 257 of the Second Regular Session of the 59th Legislature (2024). Some sections may be more current, see credits for details.
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