Oxford (Freedom) NYC

[Alex Brecher 10,512]

All I needed was a referral from my primary doctor to Dr. Ren . Once Dr. Ren received his faxed referral I was good to go.

[Alexandra 55]

Oxford's been wonderful for banding. I've only heard good things about their quick approval process.

There are docs in both the Freedom and Liberty networks who do the surgery; whether or not a referral is needed depends on the type of plan you have, not the doctor. yep, for Band candidates, Oxford insurance is a wonderful thing. Sadly, as far as I know it's only available in NJ, NY, and CT.

In NJ (and maybe elsewhere, I don't know) they also offer individual plans, which are actually competitive with group plans in NJ. Amazingly, the premium went down in August!

[Dee Martin 0]

Did anyone get covered from Oxford Freedom with a BMI around 37 with sleep Apnea and family history of Hypertenstion, Coronary Disease and high choleterol?? Also I have medical records indicating that I have had a weight probllem all my life...since 2nd grade! Please help. I know I want to go to Dr. George Fielding at NYU medical center but the nutritional assesment and psychologist are costly. I want to make sure I have a chance at approval before I go through the other steps. Please help!

[Alex Brecher 10,512]

I had a lower BMI without any health conditions. I had Oxford and used Dr. Ren (dr. Fieldings partner.)

They dealt with Oxford and getting approved was a breeze.

You shouldn't have a problem.

I've sent a few friends to Dr. Ren and all are extremely happy. Good choice!!

[chickatee 0]

Does anyone know if oxford pays for fills?

[Alex Brecher 10,512]

Does anyone know if oxford pays for fills?

Yes, they cover fills. If I'm not mistaken I used to get a referral every few months from my main physician to cover my fills at Dr. Ren. These days my Oxford plan doesn't require referrals and I only have to pay the co-pay.

[KarenB 0]

Has anyone gotten approval from Oxford for an out-of-network doc? I do have out-of-network benefits.

I have Oxford Freedom & the doc I want to use for my band removal & RNY is Shawn Garber. He works out of network & only charges the $1000 out of pocket max that Oxford charges for going out of network. I'd rather stay on LI than go into nYC for Dr. Ren--they didn't call me back anyway.

[Alexandra 55]

Karen, by definition approval is not needed for an out-of-network provider. The surgery must still be considered medically necessary, in order to be reimbursable, but you will submit the claim after the fact and the payment will go to you. You should call Oxford to determine what precertification might be necessary for the surgery itself, but as long as you realize that the deductible and coinsurance are your responsibility then using out of network providers doesn't need approval from Oxford.

[KarenB 0]

That's what I thought, then the doctor's office told me something else. I guess they want to make sure it's deemed medically necessary?? Thanks, Alex. Hey, where am I going to go after I have the RNY? There can't be a board as nice as this one!

[Alexandra 55]

Hey, where am I going to go after I have the RNY?

There can't be a board as nice as this one!

Awwwww.....

[Alex Brecher 10,512]

Awwwww.....

If you'll moderate it I'll create one just like this. What do you think ?

[theillestk 0]

Hello KarenB,

I'm seen at Dr. Garber office but with Dr. Holover. For as fills are concerned I was informed by the staff at the office is that Oxford does not pay for fills.

[KarenB 0]

Alex, If you tell me what moderating entails...I just might do it! Can a newbie (which I will be for RNY) be a moderator? I guess you'd better PM me.

[KarenB 0]

Alex, interesting, I called Oxford today to double-check if approval is necessary, and they require the same thing as for in-network. All the tests submitted to the doc then they apply for approval. Go figure.

Kay, I had was banded in Mexico and had all my fills done by Dory Ferrara in Wantagh & paid out of pocket. She does GREAT fills. But alas, as I've posted elsewhere, I have to have my band removed & am going for Gastric Bypass.

Karen

[Alexandra 55]

Alex, interesting, I called Oxford today to double-check if approval is necessary, and they require the same thing as for in-network. All the tests submitted to the doc then they apply for approval. Go figure.

That is really odd, Karen. The problem is, why would an out-of-network doctor even be willing to send anything to your insurer for preapproval? He's not a participating doc, which means he doesn't have to do ANYTHING they say if he doesn't want to. His relationship with, and responsibility is to, his patient, not his patient's insurance carrier.

I think this puts the patient in a very awkward and untenable position. I mean, sure, most doctors would want to be helpful but there are loads who don't participate with any insurers specifically because they don't want to play the paperwork/permission game. So if someone is going to one of those types and Oxford says it wants documentation prior to the service, the patient is going to be in big trouble.

I would have thought the patient would go ahead with the surgery, then collect all the information and bills and submit after the fact for a coverage determination. If they agree, payment would go directly to the patient. Certainly Oxford has the right to apply its same criteria for medical necessity when it is considering the claim, but to require pre-authorization doesn't seem right.

You've got me wondering, now. I'm also an Oxford member as well as an insurance broker, so it's important for me to really understand these things. If I have a few minutes today I think I'll call them and see what answer I get to the same question.