Oxford Health Plans

I obtained health coverage on May 22, 2009, Insurance coverage started as of June 1, 2009. Shortly after coverage started, I made a doctor appointment to look into birth control and was informed at that time that I was already in the first stages of pregnancy. On June 22, 2009, I received a letter of approval for my cesarean delivery at Newton Memorial Hospital from Oxford.

In October 2009, my doctor informed me that as of January 1, 2010, she would no longer be delivering babies. I was therefore forced to find another doctor for the delivery. On January 16, 2010, two days prior to my scheduled delivery, I received a letter from Oxford informing me I was not covered due to a pre-existing condition. Oxford's own information on coverage states that "A pre existing condition is one that has been previously given advice, diagnosis, care or treatment was recommended or received within the six months prior to your enrollment date', as defined in your certificate of coverage."

I have already filled an appeal with them that was denied, I am sending a second appeal. I do not know how they can approve the treatment and lead me to believe that everything is covered and then right before I have the child, tell me that I'm not covered. I need help to know what I can do from here to get this rectified. Please help. I now have approx $65,000 in medical bills. I am concerned about this going on to my credit report because I am trying to look for a house and if these bill show up on my credit report, I will not be able to qualify for a mortgage. This whole situation has caused much stress and aggravation for me and my children. I believe Oxford is just trying to get out of paying for the medical bills. I have documentation for everything that I have stated here.

My mother was ill. She was three years post breast cancer, stage 3. She developed complications which lead all her doctors to believe she had lung cancer. Several tests were ordered by her thoracic surgeon Eric Presser, one of them a PET scan of the Brain. These tests were ordered with supporting documentation for medical necessity. All were approved with the exception of the brain scan. It was concluded my mother had lung cancer and a lower right lung lobectomy was scheduled and performed.

As a result of the surgery my mother developed DVTs, which traveled to her lungs, compromising her heart. She also developed neuropathy in her right leg, which led to a return through the ER to Mort Short University in Manhasset. Where a scan of her brain was performed and a brain tumor and a "bleed" were found. This brain tumor did not developed as per the doctors in two weeks. After a long struggle on March 3rd, my mother passed away from complications of the results of the surgery, combined with the cancer.

My mother was my two sisters surviving parent. We completely understand the unpredictability of cancer and its effects on the human body, however, if our mother was aware of the brain tumor which caused the quality of her last days on this earth to be unnecessarily compromised, as we understand she still had the cancer, we believe her choice of care and the quality of her last days would have been just that, her choice, not the medical community's choice. And she would not have suffered, unnecessarily the way she did.