Frequently Asked Questions
What is Oklahoma Complete Health?
Oklahoma Complete Health will begin offering services on April 1, 2024 to:
- Children in Foster Care
- Designated children in the custody of the Office of Juvenile Affairs
- Former Foster Child(ren) up to 25
- Children receiving Adoption Assistance
- Children with an open prevention service case (PSC) through CWS
What is a Contracted Entity (CE)?
A CE is an insurance company that contracts with providers and medical facilities to provide health care services to its Members.
What services are covered under Oklahoma Complete Health?
Oklahoma Complete Health services include physical health, behavioral health, long-term care, and community benefits.
Do I have to pay to be enrolled in Oklahoma Complete Health?
No. There is no cost to enroll in Oklahoma Complete Health. Some members may pay minimal copayments for doctor visits and hospital services.
How do I know if my doctors are contracted with a SoonerSelect Children's Specialty Program CE?
Ask your doctors if they are contracted with SoonerSelect Children’s Specialty Program.
You can check the Find A Provider webpage on our website to view our online provider directory or consult our Provider Directory.
If you have questions about our doctors, contact Oklahoma Complete Health Member Services at 1-833-752-1665 (TTY: 711).
Can I change my Primary Care Physician (PCP)?
Yes. You can change your PCP at any time. Please call Member Services at 1-833-752-1665 (TTY: 711) to select or change your PCP.
I need to see a specialist, what do I need to do?
You do not need a referral to get an examination from an in-network specialist. However, we encourage you to talk with your PCP before you see a specialist. There are some treatments and services that will need prior approval. Your PCP will be able to tell you what they are. You can also call Member Services at 1-833-752-1665 (TTY: 711) if you have questions about whether you need a referral for a particular service.
Can I see an Out-of-Network Provider?
A participating provider is a physician or other provider who is contracted with or employed by Oklahoma Complete Health to deliver services under the SoonerSelect program. A non-participating provider is a physician or other provider who has not contracted with or is not employed by Oklahoma Complete Health to deliver services under the SoonerSelect program.
If we do not have a specialist in our provider network who can give you the care you need, we will get you the care you need from a specialist outside our plan, or an out-of-network provider.
For help and more information about getting services from an out-of-network provider, talk to your primary care provider or call Member Services at 1-833-752-1665 (TTY: 711).
You can receive family planning services (birth control) from a doctor that is not an Oklahoma Complete Health doctor. You do not have to get a referral from your PCP, but you must visit an Oklahoma SoonerSelect Children's Specialty Program provider. If you are AI/AN, you may receive services from any Indian Healthcare Provider (IHCP), even if the IHCP is out of network.
What servcies are not covered?
Oklahoma Complete Health can choose not to cover certain services because of an objection on moral or religious grounds. Currently, Oklahoma Complete Health does not object to any services based on moral or religious grounds. If this changes in the future, and you want to leave our plan because of this objection, you have the right to do so. It is considered a good cause.
How do I disenroll from Oklahoma Complete Health? What is the length of enrollment and my rights?
You may change CEs, without showing cause, during your first 90 days of enrollment, or during the 90 days following the date OHCA sends you notice of that enrollment, whichever is later.
After your period for Disenrollment from the Oklahoma Complete Health plan has lapsed, you will remain enrolled with the Oklahoma Complete Health until the next annual Open Enrollment Period, unless:
- You are disenrolled due to loss of eligibility;
- You become a foster child under custody of the State;
- You become juvenile justice involved under the custody of the State;
- You are a Former Foster Child or Child Receiving Adoption Assistance and opts to enroll in the SoonerSelect Children’s Specialty Program;
- You demonstrate cause:
- You move out of Oklahoma Complete Health’s service area;
- You require specialized care for a Chronic Condition and you or your representative, the Oklahoma Complete Health, OHCA and receiving CE agree that assignment to the receiving CE is in your best interest;
- You seeks covered benefits that Oklahoma Complete Health does not cover for moral or religious reasons;
- You need related services (for example a cesarean section and a tubal ligation) to be performed at the same time; not all related services are available within the network; and your PCP or another Provider determines that receiving the services separately would subject the you to unnecessary risk;
- You have filed and prevailed in a Grievance regarding poor quality of care, lack of access to services covered or lack of access to Providers experienced in dealing with the your care needs or other matters deemed sufficient to warrant Disenrollment; or
- You have been enrolled in error, as determined by OHCA.
- A temporary loss of eligibility or enrollment has caused you to miss the annual Disenrollment period, then you may disenroll without cause upon reenrollment; or
- OHCA imposes Intermediate Sanctions on Oklahoma Complete Health and allows you to disenroll without cause.
What is the service area covered by Oklahoma Complete Health?
Oklahoma Complete Health currently offers Managed Care services statewide in Oklahoma.