Health insurance; Ensuring Transparency in Prior Authorization Act; definitions; disclosure and review of prior authorization; adverse determinations; consultation; reviewing physicians; utilization review entity; exception; retrospective denial; length of prior authorization; continuity of care; standard for transmission of authorization; failure to comply; severability; effective date.

This Oklahoma law, known as the Ensuring Transparency in Prior Authorization Act, requires health insurers and review entities to clearly explain why they deny coverage for medical services and to consult with other doctors before making those negative decisions. The bill mandates that these entities use specific standards to evaluate care, particularly for urgent situations and chronic conditions, while also setting time limits for how long a denial can last. Additionally, the legislation establishes rules for how authorization requests must be transmitted electronically and defines key terms like "medically necessary" to ensure consistency across the state's health insurance system.