§ 7301. Dental plan fee regulation--Appeal procedures
Oklahoma Statutes AnnotatedTitle 36. Insurance
36 Okl.St.Ann. § 7301
§ 7301. Dental plan fee regulation--Appeal procedures
A. No contract between a dental plan of a health benefit plan and a dentist for the provision of services to patients may require that a dentist provide services to its subscribers at a fee set by the health benefit plan unless the services are covered services under the applicable subscriber agreement.
C. A health benefit plan or dental plan shall establish and maintain appeal procedures for any claim by a dentist or a subscriber that is denied based on lack of medical necessity. Any such denial shall be based upon a determination by a dentist who holds a nonrestricted license in the United States. Any written communication to a dentist that includes or pertains to a denial of benefits for all or part of a claim on the basis of a lack of medical necessity shall include the identifier and license number together with state of issuance, and a contact telephone number of the licensed dentist making the adverse determination. The dentist who reviewed the claim shall only be contacted at the telephone number provided in the written communication about the denial during business hours.
Credits
Laws 2010, c. 146, § 1, eff. Nov. 1, 2010; Laws 2013, c. 69, § 1, eff. Nov. 1, 2013.
36 Okl. St. Ann. § 7301, OK ST T. 36 § 7301
Current with emergency effective legislation through Chapter 182 of the Second Regular Session of the 59th Legislature (2024). Some sections may be more current, see credits for details.
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