Oxford no longer pays for followup care in the ER
- Wednesday, 13 December 2017 16:11
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.**
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
- Friday, 01 December 2017 09:01
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.
- Go to oxfordhealth.com and select “Members.”
- Under Links and Tools, select “Find a Physician or Facility.”
- On the next screen, select “Garden State.”
- Enter the search location.
- 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
- Saturday, 04 November 2017 08:25
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
- Monday, 27 March 2017 07:06
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
- Sunday, 26 June 2016 07:45
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
- Large group employers will need to select a new OHI plan for their affected members. This change will not impact most of your customers since only a small number of large group customers continue to offer this product. If your client is impacted by this change, our representatives will reach out to you. Representatives are prepared to work with you and your clients to help simplify this transition and minimize disruption to affected members.
- Small group employers offering both OHP and OHI plans – We will automatically move the OHP HMO members into a similar OHI plan, upon the group’s scheduled renewal date. We have enclosed information on the specific OHP plans that are being withdrawn from the market, as well as replacement OHI options for your reference. This change will not affect the group’s existing OHI plan(s). If necessary, we will add a new OHI plan to the group’s current offerings to support the population being transitioned. Information about any new OHI plan will be included in the group’s renewal package and accessible through our Oxford small group online enrollment tool, Idea Management SystemSM (IDEA). If your clients would prefer to add a different plan, please work with your clients to ensure they have selected a new OHI plan before their OHI renewal date.
- Small group employers offering only an OHP plan – These employers will need to take action to purchase a new policy before the end date of their current OHP plan. Since their current OHP plan is not renewing, the groups will not receive a renewal package from us. These groups will need to apply as a new group. For your convenience, information about a similar replacement option will be viewable in IDEA, where you can enroll groups in new coverage and upload supporting required documentation, such as tax documents and waivers. If you are not able to access IDEA, you can also send us a paper application.
- Healthy NY groups will be offered similar coverage from our affiliate, Oxford Health Insurance (OHI). These groups will not have to complete a new application for coverage. We will ask them only for the Healthy NY Recertification Form, which is a standard part of the annual renewal process.
Groups that continue to meet Healthy NY requirements and submit the Form will be automatically moved into the new Healthy NY OHI plan, upon the group’s scheduled renewal date. Groups that do not complete the Form, no longer meet Healthy NY requirements or would like to choose a different plan can re-apply for Oxford small group coverage in an OHI plan.
- Oxford Individual plan members will need to take action and must enroll in a new plan to have health insurance in 2017. The last day of coverage for these members, under their current plan, is December 31, 2016. We encourage you to work with your affected clients to seek replacement coverage through the New York State of Health, the Official Health Plan Marketplace (“the Marketplace”). The Marketplace offers a variety of coverage options from a number of insurers and premium assistance is available for those who qualify.