Tag Archives: Oxford

Oxford no longer pays for followup care in the ER

Emergency Room Follow-Up Care Will No Longer 
Be Reimbursed as a Covered Expense

Letter to Oxford Members

We are mailing a letter to Oxford members who have recently gone to the emergency room for follow-up care. The letter will let members know where follow-up care is covered and that where they go for medical care affects how much they have to pay out-of-pocket.

Oxford medical plans do not cover follow-up care services received in an emergency room.* If an Oxford member chooses to get follow-up care in an emergency room, the claim will be denied and the member will be responsible for the total cost of the visit.

Action required of producers.
Please be familiar with this letter, should your clients have questions. Members are encouraged to get their follow-up care after an emergency room visit (like stitch removal or a bandage change) from their primary care physician (PCP) or the appropriate specialist based on their care needs. Members with urgent needs also can get follow-up care at an urgent care center that participates with their Oxford network.**

More information.
Oxford members who have questions about their options for receiving covered medical care, including care following an emergency room visit, should call the toll-free phone number on their health plan ID card. For help with choosing a PCP or locating a participating (in-network) urgent care facility, members can also call us at this number or use the online provider search tool on their member website.

Oxford expands the Garden State Network

We’re pleased to announce that we will be expanding the Oxford Garden State Network to include access to physicians and hospitals that participate with the Oxford Metro NetworkSM in New York.


New and existing Garden State Network members will be able to receive in-network care from Metro Network physicians on Jan. 1, 2018.

More than double the provider access.

The Garden State Network offers easy, no-tiered access to more than 22,000 doctors and 62 hospitals throughout New Jersey. Enhancing the Garden State Network with the Metro Network allows members to receive care from an additional 28,000 physicians and 76 hospitals in the Oxford New York service area.

How to find a participating provider.

To help provide easier access to available New York doctors and hospitals, current or prospective Garden State Network members can find a participating New York physician or hospital within the Garden State Network online search tool. The steps to locate a provider are below.

  1. Go to oxfordhealth.com and select “Members.”
  2. Under Links and Tools, select “Find a Physician or Facility.”
  3. On the next screen, select “Garden State.”
  4. Enter the search location.
  5. Complete the search criteria on the next page and select “Search.” Or, use the supplied categories to narrow the search.

Changes to Oxford Group Plans for 2018

For 2018, Oxford, while eliminating some plans, has increased the number of options to 46.  Increases for this year look to be around 5.2%.  Liberty advantage is new, with 2 referral-required plans.  Most of the plans have changed to a $20 Lab copay (from 100%), and the ER copay increasing to $700.  Rx deductibles on some plans are increasing from $100 to $200.

The pharmacy network on the Metro plan is the Value network (no CVS or Target).  The Metro network still does not include Northwell, Stonybrook, NYU or Maimonides.

From an underwriting standpoint, parental waivers will now be accepted as valid – critical on younger groups.

Oxford Network Updates

oxford health plan with logo

Oxford, a subsidiary of United healthcare, continues to experience network growth in NY and NJ.  Here are the growth rates and raw numbers by network:

Read more ...

Oxford pulling HMO and POS from NY Market

Beginning with January renewals, Oxford will no longer make the Oxford HMO and POS plans available.  the PPO and EPO plans will continue to be available.  This impacts a lot of groups, as the LIberty HMO was the “affordable” alternative for a company that wanted to keep Oxford.

The company also has indicated it is leaving the individual off-exchange market in NY as well.




Oxford Health Plans (NY), Inc. (OHP) License Withdrawal,
Effective January 1, 2017, Upon Renewal

We have conducted a review of our entire portfolio, which has led us to the decision to exit the commercial market on our Oxford Health Plans (NY), Inc. (OHP) license in 2017. This change will result in withdrawal of our individual and small group OHP New York HMO products and our large group OHP New York POS product. This change will occur on your clients’ 2017 renewal date, beginning January 1, 2017. Please work with your affected clients to ensure they have selected a new OHI group plan before their current coverage ends.

This change does not affect our Oxford Health Insurance, Inc. (OHI) plans. Our OHI portfolio in New York offers a wide range of coverage options for employers of all sizes.

Impacted groups and members will receive a notice from us approximately 180-days prior to their 2017 coverage end date. The notice will outline the actions they need to take and other available coverage options. Samples of the 180-day communications are enclosed. The first mail drop to January 2017 renewing groups, their members, and individual policy holders will be postmarked by July 1, 2016, with subsequent mailings issued monthly thereafter to renewing groups and their members through June 2017.

What this means for your clients

December 2018
« Nov    

Sign Up To Our Newsletter

Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
FINRA.org - SIPC - Brokercheck