Most recently a New York woman was charged for using a doctor outside the Oxford Health Plan network. It's not unusual for an insurance company to bill for extra charges for using an out-of-network doctor. What is a cause for concern is that the hospital was in-network, (i.e. one hospital that Oxford insurance recognized) yet she was charged for the full hospital bill. In cases like this, the patient usually pays a small fee to use an out-of-network doctor at an in-network hospital.
Another cause for concern is that Oxford insurance did not make it clear to the hospital that the patient was expected to pay both a deductible and 30 per cent of the remaining costs until after the surgery was complete. The patient expected to pay only 30 per cent of the surgeon's fee. She did not expect to pay 30 per cent of hospital costs as well.
This is not the only time Oxford insurance and its parent company United Health Group have been in trouble. Earlier this year, Oxford insurance told its subscribers that medical care at Jamaica Hospital Medical Center would no longer be covered. The insurance company gave its subscribers a month to make alternate medical arrangements. Oxford insurance also told subscribers that they would need to find new doctors, since some previously covered doctors were being removed from the medical plans.
In response, Jamaica Hospital is suing Oxford insurance. Oxford's refusal to cover medical care at Jamaica Hospital follows a major contract dispute. In 2004, Oxford agreed to increase the rates it pays the hospital but for a year following the agreement, the insurance company continued to pay the old rates.
Jamaica Hospital also claims that Oxford insurance tried to make the hospital coerce anesthesiologists into joining with the insurance company.
Oxford insurance was taken over by UnitedHealth Group in 2004.