SoonerSelect: Medical Coverage

As a Humana Healthy Horizons in Oklahoma member, you get all medically necessary, Medicaid-covered services at no cost to you. Medically necessary means you need the services to prevent, diagnose, or treat a medical condition. The following services are covered. See your Member Handbook for more information about:

• When a prior authorization (preapproval) is needed
• When a referral is needed
• Service definitions
• If the service has eligibility requirements (e.g., some services may be available only to members under age 21, etc.)

Covered services include:

• Allergy services
• Ambulance and wheelchair van transportation
• Behavioral health services (including mental health and substance use disorder treatment)
• Certified nurse midwife services
• Certified nurse practitioner service
• Chemotherapy services
• Chiropractic services
• Dental emergencies
• Diagnostic services (x-ray, lab work, etc.)
• Durable medical equipment (e.g., breast pump, breast milk storage bags, walking aid, blood pressure equipment)
• Emergency services
• Family-planning services and supplies
• Gynecological (OB-GYN) services
• Home health services
• Hospice care
• Inpatient hospital services
• Maternity care
• Nursing facility services
• Outpatient hospital service
• Pharmacist services
• Physical and occupational therapy
• Physician services
• Prescription drugs, including certain prescribed over-the-counter drugs
• Preventive breast cancer and cervical cancer screenings
• Primary care provider services
• Screening and counseling for obesity services
• Shots (immunizations)
• Specialist services
• Speech and hearing services, including hearing aids
• Telehealth services
• Vision (optical) services
• Well-child (Healthcheck) exams for children under the age of 21
• Yearly well-adult exams

You may need to get approval before getting any of the above screenings and diagnostic testing services. This preapproval is called prior authorization.

To learn more about prior authorization:

• Refer to your Member Handbook
• Call Member Services at 855-223-9868 TTY:711

You, your authorized representative or a provider can submit a prior authorization request on your behalf.

MCG Transparency Portal 

The MCG Transparency tool opens in new window  is a website that helps you understand how health care decisions are made. It explains why certain medical treatments are approved or denied by your health plan. The tool uses simple language to show the rules and facts doctors use to decide if care is needed. This makes it easier for you to know why you can or cannot get certain medical services.