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317:45-11-11.Insure Oklahoma IP adult non-covered services

[Revised 09-14-18]

Certain health care services are not covered in the Insure Oklahoma IP adult benefit package listed in OAC 317:45-11-10. These services include, but are not limited to:

(1) services not considered medically necessary;

(2) any medical service when the member refuses to authorize release of information needed to make a medical decision;

(3) organ and tissue transplant services;

(4) weight loss intervention and treatment including, but not limited to, bariatric surgical procedures or any other weight loss surgery or procedure, drugs used primarily for the treatment of weight loss including appetite suppressants and supplements, and/or nutritional services prescribed only for the treatment of weight loss;

(5) procedures, services and supplies related to sex transformation;

(6) supportive devices for the feet (orthotics) except for the diagnosis of diabetes;

(7) cosmetic surgery, except as medically necessary and as covered in OAC 317:30-3-59(19);

(8) over-the-counter drugs, medicines and supplies except contraceptive devices and products, and diabetic supplies;

(9) experimental procedures, drugs or treatments;

(10) dental services (preventive, basic, major, orthodontia, extractions or services related to dental accident);

(11) vision care and services (including glasses), except services treating diseases or injuries to the eye;

(12) physical medicine including chiropractic and acupuncture therapy;

(13) hearing services;

(14) non-emergency transportation and emergency air transportation;

(15) allergy testing and treatment;

(16) hospice regardless of location;

(17) Temporomandibular Joint Dysfunction (TMD) (TMJ);

(18) genetic counseling;

(19) fertility evaluation/treatment/and services;

(20) sterilization reversal;

(21) Christian Science Nurse;

(22) Christian Science Practitioner;

(23) skilled nursing facility;

(24) long-term care;

(25) stand by services;

(26) thermograms;

(27) abortions (for exceptions, refer to OAC 317:30-5-6);

(28) services of a Lactation Consultant;

(29) services of a Maternal and Infant Health Licensed Clinical Social Worker;

(30) enhanced services for medically high risk pregnancies as found in OAC 317:30-5-22.1;

(31) ultraviolet treatment-actinotherapy;

(32) private duty nursing;

(33) payment for removal of benign skin lesions;

(34) sleep studies;

(35) prosthetic devices; and

(36) continuous positive airway pressure devices (CPAP).

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.