Tag Archives: Oxford

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 to tell their Oxford patients if they are recommending, involving or referring a nonparticipating (out-of-network) assistant surgeon or co-surgeon in the member’s care. The protocol is consistent with New York law that includes protection for consumers from surprise medical bills.

What is changing?

consent form has been created to confirm the members choice of provider when assistant or co-surgeon services are needed. Beginning Jan. 1, 2019, doctors and members will discuss the option of a non-participating assistant or co-surgeon and the financial consequences of using an out-of-network provider. Members will read and sign the consent form confirming their choice to use a network or out-of-network provider and their understanding of the financial impact.

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 reference.

Attachments

  • Broker eBulletin
  • Sample UnitedHealthcare fully insured member letter
  • Sample Oxford member letter
  • Sample UnitedHealthcare employer letter template
  • Sample Oxford employer letter template

 

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.

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 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.

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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.
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