Vision insurance; reimbursements; Medicare or Medicaid; non-Medicare reimbursements; charges; services; ophthalmic materials; nonaffiliated labs or frame vendors; effective date.
Summary
HB3928 would revise Oklahoma’s vision insurance reimbursement rules and add new protections for optometric physicians and other vision care providers. The bill requires insurers and prepaid vision plans to reimburse licensed optometric physicians for covered services at no less than the 60th percentile of usual and customary charges in the same geographic region, as determined by a nationally known independent nonprofit and the Oklahoma Insurance Commissioner. It also requires that reimbursement schedules be made available before a provider accepts a contract, and it bars plans from using nominal reimbursements or marketing services as covered when they are not meaningfully reimbursed.
The bill further limits how vision plans can structure payments and audits. It prohibits offsetting increases in reimbursement for covered services by reducing payments for ophthalmic materials unless the change applies uniformly to all providers, bars reductions for providers who use nonaffiliated labs or frame vendors if credentialing standards are met, and forbids extrapolated audits of vision care providers. It also requires disclosure of average reimbursements to affiliated and independent providers and prohibits plans from steering patients to plan-owned entities without notice of ownership.
Impact
HB3928 would amend existing Oklahoma vision insurance law, specifically 36 O.S. Supp. 2025, Section 6973, and would add new statutory requirements governing reimbursement rates, contract terms, audit practices, ownership disclosures, and provider payment comparisons. The bill affects insurers, prepaid vision plans, vision benefit managers, HMOs, nonprofit optometric service and indemnity corporations, and their affiliates and contractors, while directly benefiting licensed optometric physicians and independent vision care providers. It would take effect November 1, 2026, if enacted.
Sentiment
The available voting history suggests the bill has received generally favorable treatment in committee, with the House Insurance Committee voting 4-1 to do pass as amended by committee substitute. The bill’s movement to the Commerce and Economic Development Oversight committee with a do-pass recommendation indicates continued legislative interest. No committee transcript was provided, so the record shows support at the committee level but does not include detailed public debate or floor sentiment.
Contention
The main points of contention appear to center on reimbursement levels and plan control over provider economics. The bill is designed to raise payments to optometric physicians and prevent insurers or vision plans from offsetting those increases by lowering payments for frames, lenses, contacts, or other ophthalmic materials. It also restricts the use of affiliated labs, frame vendors, and plan-owned clinics in ways that could limit insurer leverage over provider networks. These provisions likely reflect a dispute between independent optometrists seeking higher and more transparent reimbursement and vision plans seeking flexibility in pricing, contracting, and audit practices.
State Medicaid program; medically necessary; donor human milk-derived products; reimbursement; promulgation of rules; policy or procedure; Oklahoma Health Care Authority; federal approval; effective date.
Health insurance; ambulance service provider; providing for establishment of certain database; modifying reimbursement rates and criteria for certain ambulance services. Effective date.