How Oxford is handling the NY “surprise medical bill” law

Oxford is pushing out policy in accordance with the surprise medical billing law in New York to create more transparency and make providers disclose when they are referring members to out of network lab facilities to reduce out of network utilization without the member knowing they were being sent to a non-par lab. 


“We strive to make health care simpler and easier for our members to understand. Going out-of-network usually means greater out-of-pocket costs for the members. Our goal is to help make our members aware of their choice of providers and the financial implications of going out-of-network.


  • Under the new protocol, New York Oxford providers are required to inform their Oxford patients if they are recommending, involving or referring a non-participating (out-of-network) laboratory or pathologist in the member’s care
    • The protocol is consistent with a recent New York law that includes protection for consumers from “surprise” medical bills


  • Effective 9/1/2015 Oxford members will read and sign the attached Consent Form confirming their choice to use either a network or out-of-network provider and their understanding of the financial impact of the decision


  • NY Oxford providers are required to follow the member’s instructions indicated on the consent form before referring the member for services accordingly”