Payment for covered benefits rendered to Insure Oklahoma/O-EPIC IP members, as shown in OAC 317:45-11-10 and not listed as a non-covered service in OAC 317:45-11-11, is made to contracted Insure Oklahoma/O-EPIC IP healthcare providers for medical and surgical services within the scope of OHCA's medical programs, provided the services are medically necessary as defined in OAC 317:30-3-1(f).

• (1) Coverage of certain services requires prior authorization as shown in OAC 317:45-11-10 and may be based on a determination made by a medical consultant in individual circumstances;
• (2) The decision to charge a copayment for a missed visit is at the provider's discretion;
• (3) The provider may collect the member's co-pay in addition to the SoonerCare reimbursement for services provided; and
• (4) The provider may refuse to see members based on their inability to pay their co-pay.