Oxford New Assistant Surgeon and Co-Surgeon Protocol eff Jan 1, 2019

NOTE- in the past an in-network surgery was generally considered in network for all providers.  This is slowly changing.. and may have financial implications, as most Oxford members do NOT have out of network coverage:   We are implementing an assistant surgeon and co-surgeon services protocol with our New York participating (network) providers. Under the protocol, network providers are required …

Oxford/United health agrees with CityMD

Highlights We are pleased to announce that UnitedHealthcare has reached a new agreement with CityMD. Members may continue to use CityMD on an in-network basis, with no disruption in care. We are sending letters to impacted members who got our earlier notice about the potential network disruption to let them know about this good news. Sample letters are enclosed for your …

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 …

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. Timing. 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 …

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 …

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 …

Are you being forced to use mail order?

We have been hearing some issues pop up on this so we wanted to send it back out again.  Members for NY Oxford groups (small and large) are not required to use Mail Order, they are being gently nudged to do so.   If they want to opt out they can either call the Oxford number on their card or …

Oxford now enforcing drug card rules

As you may be aware, in 2014 Oxford small group NY and Conn went to a mandatory generic Rx card, which they called the “Ancillary charge program”.  If you wanted a name brand drug and there was a generic available you were supposed to pay the difference (the ancillary charge) in cost between the name brand and the generic, even …

Stonybrook NOT in Oxford Metro

Despite assurances to the contrary, Oxford has now announced that Stonybrook University Medical Center will not participate in the Oxford Metro Network.  This announcement of course, comes far too late for everyone who had to choose their individual plan by 12/15….