Oxford New York: Gastroenterologists must use Oxford participating anesthesiologists

Oxford New York gastroenterologists are required to use Oxford participating anesthesiologists

As a reminder, our existing protocols require New York Oxford gastroenterologists performing non-emergent procedures with anesthesia in-office (IO) or in an ambulatory surgery centers (ASC), to use an Oxford participating anesthesiologist unless:

• The member agrees in writing pre-service to receive services from a non-participating anesthesiologist by signing the Non-Participating Provider Consent Form and understands that the use of this provider will be:
  • Out of network: For members with out-of-network benefits, non-participating anesthesiologist claims will be paid at the out-of-network benefit level. Out-of-network cost shares and deductibles will apply.
  • Denied: For members without out-of-network benefits, non-participating anesthesiologist claims will be denied as not covered because the member has no coverage for services provided by non-participating providers. Members will therefore be responsible for the entire cost of the service.
• OR: An in-network exception has been approved.

Note: As a general matter, GAP exceptions should not be necessary. We maintain a network of in-network anesthesiologists.

Requesting an exception
If requesting an in-network exception to have a non-participating anesthesiologist covered as if they were participating with the Oxford network, the participating provider must make the exception request. The exception request will not be accepted from the non-participating anesthesiologist.

• The In-Network Exception request must be made no less than 14 days in advance of the scheduled procedure in order to avoid delays in care and alleviate potential complications with the patient’s required preparations for the procedure.
• If the participating provider requests an In-Network Exception less than 14 days in advance of the scheduled procedure, the In-Network Exception request will be processed per Oxford’s standard guidelines; however, the participating provider will receive an administrative denial for their claim for failure to follow protocol.

Please note that this does not reflect a change to any existing protocol or payment policy.

Questions?
To find a participating anesthesiologist in your area, use the Find a Provider tool on UHCprovider.com.

PCA-22-00562-VCNews