© Peter KuperIn 2004 Oxford agreed to a new contract that increased the rates it paid the hospital, then continued to pay the old rates for more than a year after MediSys and Oxford negotiated new contracts to set the rates the insurer would pay to two MediSys hospitals, Flushing Hospital Medical Center and Jamaica.
Oxford drafted the contracts, and MediSys signed them and returned them to Oxford. But after a few months, MediSys realized that Oxford was still paying the old, lower rates, and it complained to the insurer.
At that point, Oxford raised a new and unexpected subject: the anesthesiologists at Flushing Hospital. The anesthesiology group does not have an agreement with Oxford to be part of its network of doctors. When Oxford members have surgery at Flushing, the anesthesiologists bill the insurance company for their full fees, not the lower rates Oxford would negotiate with in-network doctorsOxford responded by asking the hospitals to pressure the Flushing anesthesiologists to join Oxford's network. MediSys rebuffed that request, saying it was up to the anesthesia group to make its own insurance arrangements.
When repeated protests produced nothing, Jamaica officials raised the possibility this year of canceling the contract, but Oxford talked them out of it.
Then, doctors and patients received letters from Oxford informing them that as of May 2, Jamaica would no longer be an Oxford provider. Doctors who had admitting privileges at other hospitals were told that they would have to take their patients elsewhere. Doctors who had privileges only at Jamaica were told that they would no longer be paid to treat Oxford members, and their patients were told to find new doctors.
“These are mostly elderly people who have heart disease and diabetes and arthritis, people who see a lot of different specialists, and they were panicked," "And all of a sudden, they're told they can't go to all those docs at Jamaica”. They scrambled to make arrangements at other hospitals. Doctors said they were inundated by calls from patients requesting their medical records so they could change doctors.
Many were like the woman in her 60's with chronic hepatitis C, "She came in one day hysterically crying, completely distraught, saying she got this letter from Oxford that I could no longer be her doctor," Dr. Basello said. "Later, she missed appointments because she didn't think she could keep coming to me”.
Jamaica and the state say, Oxford has not made any retroactive payments and because of the lag in billing, they do not know yet whether Oxford is paying the new rates.
Calls to Oxford were referred to its parent company, UnitedHealth Group, which bought Oxford in 2004. Jamaica officials noted that the Oxford moves they object to happened after the July 2004 takeover by UnitedHealth, one of the nation's largest and most profitable health insurers.
Excerpts; read the whole artcle at : http://www.nytimes.com/2006/05/30/nyregion/30jamaica.html and special thanks to Peter Kuper for the artwork
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