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STATE OF OKLAHOMA
1st Session of the 60th Legislature (2025)
HOUSE BILL 1853 By: Schreiber
AS INTRODUCED
An Act relating to medical expenses; defining terms;
authorizing individuals to pay for medical expenses
out-of-pocket; directing insu rance providers to count
certain payments toward deductibles, coinsurance,
copayments; providing for documentation requirements;
providing for codification; and providing an
effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6060.50 of Title 36, unless
there is created a duplication in numbering, reads as follows:
As used in this section:
"Health care service" means a service for the diagnosis,
prevention, treatment, cure, or relief of a health condition,
illness, injury, or disease, including a prescription drug or
device, and does not include an emergency medical service.
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6060.51 of Title 36, unless
there is created a duplication in numbering, reads as follows:
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A. An enrollee may choose to pay for a health care service out -
of-pocket from an out-of-network provider. If an enrollee
negotiates for a lower cost from an out -of-network provider than the
average allowed amount paid by the carrier to a network provider for
a comparable health care service, and the enrollee pays for the
health care service ou t-of-pocket, the enrollee may send
documentation, which may be sent electronic ally, to the carrier,
that provides the following:
1. The health care service the enrollee or patient received and
the health care provider 's name and contact information;
2. If an order is required by the enrollee's policy, the order
from the health care provider given to the enrollee or patient and
the final bill or statement for the health care service;
3. The average payments made by the carrier to network entities
or providers for comparable health care services if this information
is made available to the enrollee pursuant to this part; and
4. The negotiated cost of the health care service that the
enrollee received:
a. the enrollee paid out -of-pocket for the health care
services received, and
b. the health care entity is not making a claim against
the carrier for payment for the health care service
provided to the enrollee or patient.
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B. A carrier that receives the documentation described in
subsection A of this section shall count the full amount that the
enrollee paid out-of-pocket toward the en rollee's deductible,
coinsurance, copayment, or other cost -sharing amount:
1. If the heath care service is included under the enrollee 's
health plan; and
2. The enrollee negoti ated for a lower cost for the health care
service than the average allowed amount paid by the carrier to
network providers for that comparable health care service.
C. The amount counted toward an enrollee 's out-of-pocket
deductible, coinsurance, copayment , or other cost-sharing amount
must not exceed the total amount that the cover ed person is required
to pay out-of-pocket during a contractually agreed upon period of
time for health care services that are included under the covered
person's insurance plan, and does not carry over once a new contract
or agreement period for the insurance plan begins.
SECTION 3. This act shall become effective November 1, 2025.
60-1-10715 TJ 01/14/25