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Oxford Health Plans Fraud

Oxford Health Plans and it's parent company, UnitedHealth Group, have allegedly been participating in unfair medical insurance practices designed to avoid paying hospitals what is owed for out of network medical care. These fraudulent actions have resulted in financial loss to both patients and hospitals using the plan.

One woman underwent a medical procedure in a hospital in Oxford's network with a surgeon of her own choosing. She expected that all hospital fees, except the surgeon's fees, would be covered under her insurance plan. She learned months later when she received a bill that she was responsible for 30 percent of all the hospital costs - amounting to almost $5,000 - because her surgeon was out of network.

Furthermore, Oxford declined to pay the full amount of the cost of the procedure to the hospital, claiming the patient was responsible for the remainder of the fees. Both the patient and the hospital allege the only information they were given from Oxford about the operation was a letter authorizing the surgery. There was no mention that the treatment was considered out of network.

According to an Oxford spokesperson, the plan's recipients receive a coverage policy, which outlines that using a non-network physician would deem the entire treatment non-network. However, the Healthcare Association of New York has filed a complaint alleging the coverage policy is not straightforward and misrepresents what the plan offers. "Nobody would understand what it's supposed to mean," said Daniel Sisto, presidents of the Healthcare Association.

The state Department of Health claims that UnitedHealth Group is frequently in violation of state rules by denying payment to doctors and hospitals. Oxford is also the most complained about insurance company among physicians. The company accuses doctors of years of over-billing - with little evidence - and demands large return payments.

Consumers who believe they have been defrauded by Oxford Health Plans, UnitedHealth Group, or other insurance company's fraudulent actions should contact our consumer fraud lawyers today to learn more about their legal rights and options.