§ 6803. Coverage of services--Requirements for insurers
Oklahoma Statutes AnnotatedTitle 36. InsuranceEffective: January 1, 2022
Effective: January 1, 2022
36 Okl.St.Ann. § 6803
§ 6803. Coverage of services--Requirements for insurers
A. For services that a health care professional determines to be appropriately provided by means of telemedicine, health care service plans, disability insurer programs, workers' compensation programs, or state Medicaid managed care program contracts issued, amended, or renewed on or after January 1, 1998, shall not require person-to-person contact between a health care professional and a patient.
C. Any health benefit plan that is offered, issued or renewed in this state by an insurer on or after the effective date of this act1 shall provide coverage of health care services provided through telemedicine, as provided in this section.
D. An insurer shall not exclude a service for coverage solely because the service is provided through telemedicine and is not provided through in-person consultation or contact between a health care professional and a patient when such services are appropriately provided through telemedicine. An insurer may limit coverage of services provided by telehealth consistent with coding and clinical standards recognized by the American Medical Association or the Centers for Medicare and Medicaid Services as covered if delivered by telehealth or telemedicine, except as agreed to by the insurer and provider.
E. An insurer shall reimburse the treating health care professional or the consulting health care professional for the diagnosis, consultation or treatment of the patient delivered through telemedicine services on the same basis and at least at the rate of reimbursement that the insurer is responsible for coverage for the provision of the same, or substantially similar, services through in-person consultation or contact.
I. An insurer shall not impose any type of utilization review on benefits provided through telemedicine unless such type of utilization review is imposed when such benefits are provided through in-person consultation or contact. Any type of utilization review that is imposed on benefits provided through telemedicine shall not occur with greater frequency or more stringent application than such form of utilization review is imposed on such benefits provided through in-person consultation or contact.
J. An insurer shall not restrict coverage of telemedicine benefits or services to benefits or services provided by a particular vendor, or other third party, or benefits or services provided through a particular electronic communications technology platform; provided, that nothing shall require an insurer to cover any electronic communications technology platform that does not comply with applicable state and federal privacy laws.
Credits
Laws 1997, c. 209, § 3, eff. July 1, 1997; Laws 2021, c. 420, § 2, eff. Jan. 1, 2022.
Footnotes
O.S.L. 2021, c. 420, eff. January 1, 2022.
36 Okl. St. Ann. § 6803, OK ST T. 36 § 6803
Current with emergency effective legislation through Chapter 378 of the Second Regular Session of the 59th Legislature (2024). Some sections may be more current, see credits for details.
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