'Should Not Be The Case:' SoonerCare Member Treatment Cancelled Amid Transition To SoonerSelect

SoonerCare rolled out a new managed care program called Sooner Select, transitioning all SoonerCare members to choose between three coverage plans.

The transition to SoonerSelect was supposed to be seamless, but several providers and members were confused amid the transition.

One SoonerCare member says she's now being denied services under her chosen plan. She's asked we use only her first name for her privacy. "It was difficult for them to find a treatment for me," Jennifer, a SoonerCare member living in rural Oklahoma, said.

She receives regular infusions for her Rheumatoid Arthritis. "It's almost $16,000 per infusion," she said.

It’s a hefty price she can't pay out of pocket. "The day before I was supposed to get my infusion, I got a phone call," she explained. "We can't give you your infusions we're going to have to cancel."

Jennifer's new coverage plan under SoonerSelect took effect April 1st and her specialist is now out of network.

"They said oh there's nothing we can do we're not paying for an out-of-network provider," she said, relaying the phone conversation with her new insurance provider.

"That should not be the case, providers should not be canceling appointments," Christina Foss, Chief of Staff at the Oklahoma Healthcare Authority, said. "All services that SoonerCare members received before the transition they should still receive."

She says Jennifer's services should have been protected under a 90-day continuity of care clause. "What that allows is that all providers if they see a SoonerSelect member will get paid regardless of contract status with that particular plan," she said.

Foss says the OHCA is ready and willing to manage any confusion or miscommunication between providers, members, and the coverage plans during the ongoing transition. "That's our job as an agency is to hold these plans accountable and to make sure they're abiding by all their contractual requirements," Foss said.

The OHCA encourages any members who have run into issues with transitioning services and treatments to reach out to the agency immediately.