What Oklahoma Complete Health Really Covers Under SoonerSelect (and How to Check Yours)

You picked a plan, the ID card showed up, and now a clinic wants to know if that referral is required or if there’s a copay for today’s visit. This is where the fine print matters. Below is how Oklahoma Complete Health works inside SoonerSelect, using the same details I walk through with members when a bill or denial shows up and no one can tell you why.

Which parts are standard SoonerCare in Oklahoma, and which are Oklahoma Complete Health extras?

Start with the floor. All SoonerSelect medical plans must cover the same core SoonerCare benefits. That includes primary care, hospital care, behavioral health, labs and X‑rays, pregnancy care, and prescriptions. If it’s a standard SoonerCare service, every SoonerSelect plan covers it at the same basic cost rules for the same populations across Oklahoma.

Then there are plan “extras.” Oklahoma Complete Health adds value-added benefits on top of the core package. Examples in Oklahoma include a reward card program with specific dollar amounts for certain checkups and vaccines, enhanced non-medical rides tied to social needs, and phone access support for members in care management who don’t have reliable service. Those are plan choices, not statewide requirements, so they differ from Aetna Better Health of Oklahoma or Humana Healthy Horizons in Oklahoma.

Dental is separate. Medical coverage like checkups and prescriptions run through Oklahoma Complete Health, but dental benefits in SoonerSelect are managed by DentaQuest and LIBERTY Dental Plan. If you need a cleaning or a denture adjustment, you’ll use your dental plan card, not your medical plan card. The State’s choice-counseling line is 800‑987‑7767 if you’re not sure which dental plan you’re on.

If you need help fast, Oklahoma Complete Health Member and Provider Services answers at 833‑752‑1664 (TTY 711) on weekdays from 8 a.m. to 5 p.m. Central. There’s also a nurse advice line at the same number 24 hours a day, 7 days a week for “should I go in?” questions.

How much will I pay out of pocket with this plan?

Most members under age 21 and members who are pregnant do not pay copays. Adults who do pay copays will find the amounts printed on the Oklahoma Complete Health member ID card and listed in the plan handbook. The plan’s current copay schedule for members who are subject to cost sharing includes:

$10 per inpatient hospital day up to a $75 maximum per stay; $4 per visit for outpatient hospital, outpatient clinics, physician services, advanced practice nurse services, optometrist services, home health visits, rural health clinic visits, Federally Qualified Health Center visits, and therapy such as PT/OT/ST; $4 per laboratory or X‑ray visit; and $4 per prescription with a few $0 exceptions. The $0 list includes tobacco cessation products, prenatal vitamins, birth control, naloxone, ACIP-recommended vaccines, and medication-assisted treatment for opioid use. Behavioral health has the same $10 per day inpatient cap and $3 per outpatient visit.

Copays are waived in specific situations beyond pregnancy and age. There are no copays for emergency services, for family planning services from any Oklahoma Medicaid provider, or for preventive services delivered to expansion adults. American Indians and Alaska Natives are exempt, and members assigned a state copay exemption or who have reached their monthly cost-sharing limit also do not pay copays.

Typical confusion point: a pharmacy window asking for $4 on a medication you were told would be “free.” If that drug is a tobacco-cessation product, prenatal vitamin, birth control, naloxone, or an opioid-use-disorder medicine, that line-item should be $0. Ask the pharmacy to re-run the claim under SoonerSelect medical, not cash, and confirm the NDC matches a covered product for the $0 category.

Rewards are not copays. They are add-ons that load to a prepaid card after you complete a qualifying activity and the claim posts. On the Oklahoma Complete Health My Health Pays card, a flu shot earns $5 once per calendar year; an adult well visit earns $10 once per year; and a diabetes A1c test earns $25 once per year if you have a diabetes diagnosis. For infants, well visits pay $25 per visit in the 0–15 month and 15–30 month windows, up to the schedule limit. For pregnant members, the Notification of Pregnancy form pays $25 if completed in the first trimester (or $10 if in the second trimester), and there is a separate $10 postpartum visit reward within 7–84 days of delivery. Rewards post after the plan processes the related claim.

What needs prior authorization, and how fast are decisions made?

Some services require approval before you get them. Your primary care provider usually submits these requests through the provider portal. If you or your doctor asks the plan what’s needed, a customer service agent can explain the rule, but the official submission still has to come through the provider portal.

Timeframes are not open-ended. Oklahoma Complete Health states that standard prior authorization decisions are made within 72 hours after the request arrives, with the option to extend the review up to 14 calendar days if more information is needed and the delay is in your best interest. Expedited, or “fast track,” requests are decided within 24 hours. Inpatient behavioral health authorizations are also decided within 24 hours. If you’re already receiving a service and a new request is made to continue it, the plan must notify you at least 10 days before reducing, stopping, or restricting the service.

Referrals come up most for specialists. Many specialist visits can be scheduled without a paper referral, but some treatments and tests need prior authorization even when the visit itself didn’t. If the plan doesn’t have an in-network specialist for your condition, your provider can request an out-of-network referral. Emergencies are different. You never need prior approval for emergency care, and it’s covered even if the hospital is out of network. Family planning services are also flexible. You can get birth control and other family planning services from any Oklahoma Medicaid provider without a referral.

If a prior authorization is denied or cut back, that is called an adverse benefit determination. You have 60 days from the denial notice to appeal with the plan. If waiting 30 days for a decision would put your health at risk, ask for an expedited appeal. Standard appeals are decided within 30 days and expedited appeals within 72 hours once the plan has what it needs.

Plan extras you can actually use in Oklahoma

Rewards you can spend on essentials

The My Health Pays program is straightforward once you see the list. A few examples with dollar figures that are current for Oklahoma Complete Health: $10 for registering your online member portal, $10 for a health risk screening, $25 for childhood immunization completion (ages 0–2), $25 for adolescent immunizations (ages 10–13), and the pregnancy and postpartum rewards listed earlier. Rewards can be used toward utilities, transportation, telecommunications, childcare services, education, rent, or at Walmart for everyday items, with normal exclusions like alcohol, tobacco, and firearms.

Rides beyond medical appointments

Standard non-emergency medical transportation is available to covered appointments, arranged through your plan. Oklahoma Complete Health also lists enhanced rides tied to social needs. Members can receive up to 15 round trips per year for non-medical destinations that support health, such as a grocery store, WIC or SNAP appointments, a food bank, or a community class. The handbook explains how to schedule these and that they’re in addition to rides to medical care.

Phones and online access when you don’t have it

For members in care management who lack safe, reliable phone or internet, the plan’s ConnectionsPlus program educates members about applying for a SafeLink device and can provide a no-cost cell phone and data plan to keep you reachable for care coordination, telehealth, and emergencies. That is different from the way other Oklahoma SoonerSelect plans handle phones, shown in the comparison below.

Education and work supports in specific Oklahoma communities

Oklahoma Complete Health invests in “Health Empowerment Zones” with targeted extras. In these areas, members in K–12 who are in care management and at risk of failing core subjects can receive in-person or virtual tutoring, and adults in care management can access GED tutoring and testing vouchers. The listed zones include Adair County (ZIP 74330), McCurtain County (74944), parts of Oklahoma City (73111, 73129, 73117, 73141, 73084), and parts of Tulsa (74106, 74126, 74115, 74127, 74110). If that’s where you live and you’re in care management, ask your care manager to connect you to the specific benefit.

These examples are true plan differences. If a reward amount or eligibility matters to you, match the plan’s written list against what you or your kids will actually use this year.

When something goes wrong: grievances, appeals, and fair hearings in Oklahoma

You can file a grievance with the plan when you’re unhappy with services, a provider, or the plan’s customer service. You can submit by phone or in writing at any time. For phone, call Member Services at 833‑752‑1664 (TTY 711) Monday through Friday, 8 a.m. to 5 p.m. Central. If you write, use the plan’s grievance address: Oklahoma Complete Health, Attn: Grievance Department, P.O. Box 10353, Van Nuys, CA 91410‑0353. The plan sends a written acknowledgment within 10 days, resolves the grievance within 30 days, and will send you its resolution within 3 days after it’s decided. The plan can extend by up to 14 days if needed and in your best interest, and you can also ask for an extension if you’re gathering information.

If the issue is a coverage denial or cutback, file an appeal. You have 60 days after the denial notice to appeal to the plan. Standard appeals get a written decision within 30 days; expedited appeals are decided within 72 hours once the plan has what it needs. If you’re already receiving a service and want it to continue during the appeal, ask for continued benefits at the time you file the appeal. If you lose the appeal later, you may be responsible for the cost of the services you continued to receive during the process.

If the appeal stays denied, or the plan doesn’t decide your appeal within 30 days, you can request a State Fair Hearing with the Oklahoma Health Care Authority. You have 120 days from the adverse appeal resolution to request the hearing. You can call 405‑522‑7217 to request it by phone, or ask your caseworker to help if you prefer to file by mail or email. At the hearing, an administrative law judge who is not part of the plan reviews the case. If you want benefits to continue while you wait on the judge’s decision, say so when you request the hearing.

One last billing tip. If you receive a bill for a covered SoonerSelect service, don’t ignore it. Call Member Services at 833‑752‑1664. If the charge isn’t your responsibility under the rules above, the plan can contact the provider to correct the claim. If a provider says you owe because they’re out of network, ask whether an out-of-network referral was approved. Emergencies and family planning services have their own rules and are not limited to the plan’s network.

Key things to keep in mind

• Member Services at 833‑752‑1664 (TTY 711) answers weekdays 8 a.m. to 5 p.m. CT. The nurse advice line at the same number runs 24/7.
• Adults who owe copays pay $4 for most outpatient visits and prescriptions, $3 for outpatient behavioral health visits, and $10 per inpatient day up to $75 per stay. Many groups, including kids and pregnant members, have $0 copays.
• Common $0 prescription categories include prenatal vitamins, birth control, naloxone, tobacco-cessation products, ACIP vaccines, and medications for opioid use disorder.
• Standard prior authorization decisions come within 72 hours and expedited within 24 hours. Inpatient behavioral health is also 24 hours.
• Plan extras vary by company. In Oklahoma Complete Health, the My Health Pays card pays $5 for a flu shot, $10 for an adult well visit, and $25 for a diabetes A1c test when indicated. Humana’s listed flu shot reward is $20.
• Enhanced transportation allows up to 15 round trips per year for certain non-medical needs like a grocery store or WIC appointment, in addition to medical rides.
• Education supports are targeted to specific Oklahoma ZIP codes such as 73111 and 74106. If you live in a Health Empowerment Zone and are in care management, ask about tutoring or GED vouchers.
• Dental coverage runs through DentaQuest or LIBERTY Dental Plan, not your medical plan. If you need to switch or check your dental plan, call 800‑987‑7767.
• Grievances can be filed any time by phone or mail. Appeals must be filed within 60 days of a denial notice. State Fair Hearings must be requested within 120 days of the appeal outcome, phone 405‑522‑7217.

Reader Q&A

Do I need a referral to see a specialist on Oklahoma Complete Health?

Many specialist visits don’t require a paper referral, but some tests and treatments do need prior authorization. If the plan doesn’t have an in-network specialist for your condition, your provider can ask for an out-of-network approval. Emergency care never needs pre-approval, and you can get family planning services from any Oklahoma Medicaid provider.

What are my copays as an adult on SoonerSelect with Oklahoma Complete Health?

For adults who owe copays, most outpatient visits and prescriptions are $4, outpatient behavioral health visits are $3, and inpatient hospital days are $10 per day up to $75 per stay. Kids under 21 and pregnant members have $0 copays, and several items such as prenatal vitamins, birth control, and naloxone are always $0.

How quickly will the plan decide on a prior authorization?

Standard requests are decided within 72 hours and expedited requests within 24 hours. Inpatient behavioral health authorizations are also decided within 24 hours. The plan can extend a review by up to 14 days if more information is needed and a short delay is in your best interest.

Who do I call if my dental claim is denied?

Dental coverage is through DentaQuest or LIBERTY Dental Plan, not your medical plan. Check your dental plan and call that plan’s member services first. If you’re unsure which dental plan you’re in, call the SoonerSelect Choice Counseling line at 800‑987‑7767.

When you’re choosing among Oklahoma’s SoonerSelect plans, match the extras to your real life. If you value a higher flu shot reward or need help with a phone or non-medical rides, compare the written lists against your household’s needs for the next 12 months and pick the plan that puts dollars or services where you’ll actually use them.

Published: September 22, 2026 · Reviewed by the Oklahoma editorial team