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I am writing to express my frustration and dismay with how Oxford Health recently handled the care for my daughter, J*. J* has suffered from many breaks to her nose in the past 8 years. Due to this damage, she required a full Septoplasty to correct the structure of her nose and facial bones. Julia suffers from intense headaches, eye pain, facial pain, difficulty breathing and sleep issues. Recently, she has developed throat, ear and neck complications resulting from this damage requiring an ultrasound on her Thyroid, lymph nodes and a plethora of blood tests.
She visited Dr. ** who established that she had suffered dramatic permanent damage and would require a 4-5 hour surgery to reconstruct the damaged portions of her face. This would also require cadaver rib and cartilage components as hers are nonexistent. We filed the paperwork and it was denied. Further documentation and updates were sent including photos and a letter written by the physician. These were mailed in Monday, December 16 and 17th as they were requested by the insurance. The file was in process for over a month.
Once all documents were obtained (a second time), the file was put into appeal. The physician requested it be expedited due to the date of surgery being December 23, 2019. This was denied. They requested a peer to peer review. Also denied. This date chosen as J* will need to be monitored for 2 weeks. Time out of work was needed not only for her but for her caregivers as well. Choosing to operate two days before Christmas is certainly not ideal; however, it ensured that Julia would be cared for appropriately. Compounding the situation, J*is a new college graduate with limited time off.
Both the doctor’s office and I called Oxford daily. We begged that the file simply be reviewed to no avail. There was no concern for not only her pain but also for the time of the professionals who were prepared to care for her medically or those of us who would need to care for her after surgery. The financial constraints were also not a concern. I requested to speak to anyone who could simply review the file so we can move on.
So, now at 1:30 on December 20, 2019 we have been forced to cancel the surgery and postpone it until Jan simply because Oxford would not even attempt to meet the needs of the patient. This will result in two weeks of unpaid time not only for J* but for her father or me in addition to the cancellation of all medical professionals involved. The added stress and lack of income could have been avoided if Oxford Health had any concern or care for the people who pay for their services.
This is very disheartening and not acceptable. Your procedures are needed to process claims, this I understand, but to tie the hands of patients and medical teams while not having any process in place to meet their needs is negligent. Perhaps Oxford would like to support our family as we attempt to care for Julia while being unpaid. As part of the ***, I will be sure to elaborate on our situation during negotiations as well as send this letter to every federal, state and local agency involved with the insurance industry. Sincerely, Lauren **.
I am an elder on a fixed income... Oxford has become so expensive, when the time comes to renew, I WILL have to look elsewhere. For the most part, I have been pleased with this company, and especially the agent who has been diligent and seems to care about his clients.
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I'm paying over $1,000 out of pocket after my doctor called and faxed them herself several times. It's an endurance test with this company. As a member when you call they transfer you from person to another and you spend hours getting nowhere. Worst health insurance company I've ever used. I'm on their best plan and still get treated like garbage. Go back to Blue Cross.
I signed on United Health/Oxford about 6 months ago. The Pharma part of the plan is Optum/Rx. In going to the pharmacy to fill a script for medication, I found I was only limited to 4 pills, whether generic or brand. My doctor has for the last several years had prescribed 18. All I got was, sorry that is the allowance. I also found that Optum charges more for the pills, whether generic or brand, than the pharmacy did. I also found out there is a class action lawsuit against them for this very reason. It. Is very upsetting to know I am paying premiums and getting ripped off.
This health insurance is the worst... I have type one and they use to allow me my insulin, now they want document of having allergy to **. I have to use **, I had reactions to all of insulin. Today I still can't get approval for ** even though I use to get it from them. Today I need blood sticks to check my sugar. I can't have them. I have to wait until Monday. They are playing with someone life. They refuse to continue my Dexcom meter even though I've had it and it's made for type one. Now I am back to old days of setting alarm couple times a night to check my sugar levels. This needs to stop, we need to make drug companies need to be cap. Not having CEO make million and half while deny us medicine. This is sick.
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.
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