§36-6973. Reimbursements — Charges — Pricing — Incentivization.
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/ok/title-36-insurance/36-6973·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
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.
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.