Okla. Stat. tit. 36, § 36-6475.17
This is the official text of Okla. Stat. tit. 36, § 36-6475.17, part of Oklahoma’s Stat. tit. 36, — part of the compiled statutory law of Oklahoma, published by the state as "Stat. tit. 36,." Browse the sections below, each linked to its official government source.
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Description of external review procedures
Official statutory text
A. 1. Each health carrier shall include a description of the
external review procedures in or attached to the policy,
certificate, membership booklet, outline of coverage or other
evidence of coverage it provides to covered persons.
2. The disclosure required by paragraph 1 of this subsection
shall be in a format prescribed by the Insurance Commissioner.
B. The description required under subsection A of this section
shall include a statement that informs the covered person of the
right of the covered person to file a request for an external review
of an adverse determination or final adverse determination with the
Commissioner. The statement shall explain that external review is
available when the adverse determination or final adverse
determination involves an issue of medical necessity,
appropriateness, health care setting, level of care or
effectiveness. The statement shall include the telephone number and
address of the Commissioner.
C. In addition to subsection B of this section, the statement
shall inform the covered person that, when filing a request for an
external review, the covered person will be required to authorize
the release of any medical records of the covered person that may be
required to be reviewed for the purpose of reaching a decision on
the external review.
external review procedures in or attached to the policy,
certificate, membership booklet, outline of coverage or other
evidence of coverage it provides to covered persons.
2. The disclosure required by paragraph 1 of this subsection
shall be in a format prescribed by the Insurance Commissioner.
B. The description required under subsection A of this section
shall include a statement that informs the covered person of the
right of the covered person to file a request for an external review
of an adverse determination or final adverse determination with the
Commissioner. The statement shall explain that external review is
available when the adverse determination or final adverse
determination involves an issue of medical necessity,
appropriateness, health care setting, level of care or
effectiveness. The statement shall include the telephone number and
address of the Commissioner.
C. In addition to subsection B of this section, the statement
shall inform the covered person that, when filing a request for an
external review, the covered person will be required to authorize
the release of any medical records of the covered person that may be
required to be reviewed for the purpose of reaching a decision on
the external review.
Status: in_force · Read it on the official government site
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