Termination of Oxford's Hospital Contract with Westchester Medical Center

Dear full-time faculty and staff member, 

Earlier in the year, our office advised you that Oxford's hospital contract with Westchester Medical Center was being terminated. The contract was technically terminated as of January 15th, and in accordance with New York State law, there was a 60 day cooling-off period during which Westchester Medical Center continued to operate as an in-network facility for Oxford participants until March 17, 2009.  Unfortunately, Oxford and Westchester Medical Center were unable to reach agreement and as a result, Westchester Medical Center terminated their provider contract with Oxford.  We are very disappointed with this outcome.

We have reviewed our usage of this facility and for the last 12 months there were 27 claims which were incurred by our covered population.  In relation to the total number of claims which we had, this represents a small fraction of the total, however, we also recognize that this is an important facility for our employees.

What This Means to You:

Going forward, Westchester Medical Center will no longer participate with Oxford, and if you access services through this facility, it will no longer be treated as in-network. Employees enrolled in the EPO who access services at Westchester Medical Center will not have coverage, as there is no out-of-network benefit under this plan. Employees enrolled in our other plans will have coverage, but it will be on an out-of-network basis, which will result in higher out of pocket expenses for you.

Also, in order to be a participating provider with Oxford, a provider must have admitting privileges to an in-network facility. Oxford has indicated that only 65 of their 1,205 primary care physicians and 182 of their 2,595 specialists have solo privileges at Westchester Medical Center.  While this represents a small portion of the providers who have admitting privileges to Westchester Medical Center only, you should still check the participation status of your provider prior to incurring any expenses.  
 
In addition, Oxford processes claims based on the provider’s Tax Identification Number submitted with the claim.  You should be aware that any services that are rendered at or billed through Westchester Medical Center will be considered out-of-network. Be sure to review how your provider will be submitting their bill to Oxford prior to accessing services to avoid the issue of having to pay out of pocket expenses.  

We are continuing to monitor the situation with Oxford and will keep you informed of any future developments.
 
Sincerely,
 
Michele Ramirez
Director, University Benefits
(914) 923-2738
Fax: 914-989-8506
Email: mramirez@pace.edu