Oxford Healthcare / lack of reimbursement
In March of 2011 I had surgery to repair a hernia. With the ever-changing status of which institutions had a contract with Oxford, I checked with Southampton Hospital (SHH) as to the coverage of the surgery. I was told they are a participating hospital, that the surgery and associated services would be covered and that I was responsible for my coinsurance. I knew the surgeon I elected to perform the surgery was out-of-network. I have no outstanding bills with the hospital or surgeon.
Months later I receive a bill from East End Anesthesiology (EEA) for the surgery. I wrote a letter to Oxford concerning this bill. When I did not receive a response I called. I was told that my letter did not state I wanted to ‘appeal’ and that by not using that specific word in my first letter, my question of the bill was not considered and that I was at the end of the time period allotted for appeals.
> EEA are the only anesthetists that work at the hospital.
> I had no choice in the matter.
> Anesthesia was mandatory for the surgery could not have been performed without this service.
> I was not informed of EEA's non-participating status.
> Oxford's appeal process is not member friendly and does not serve a valid purpose to protect single members who are paying more than $6000 per year for healthcare coverage.
What Oxford considers a ‘fair and honest appeal process’ is of no value if the Grievance Board does not consider a 33% ($2750) increase to my yearly healthcare bill unfair and outrageous.