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How to Maximize your Benefits

Oxford offers plan members some helpful tips on how best to maximize your health benefits while keeping costs down.

1. Use Emergency Rooms Only in an Emergency

Before you go to a hospital emergency room, ask yourself: “Am I going to the emergency room because I have an emergency or because it is open and I don’t need an appointment?”

In 2009, more than 5,500 visits were made to emergency rooms by members covered under our Oxford plan. At an average cost of close to $1,000 a visit, the annual price tag for ER care approached $5.5 million dollars. Many of those visits were not real emergencies.

The widespread misuse of ERs is one of the reasons why healthcare is so expensive. It’s best to avoid the ER unless you have a very serious or life-threatening problem. However, if your symptoms are serious or life-threatening, head straight to the ER. 

In general, conditions that should be evaluated in an Emergency Room include:

  • Deep cuts or bleeding that won’t stop
  • Large bone fractures
  • Problems related to pregnancy
  • Knife or gunshot wounds
  • Coughing or vomiting blood
  • Chest or upper abdominal pain or pressure
  • Suspected stroke or heart attack
  • Difficulty breathing
  • Severe burns
  • Loss of consciousness
  • Seizures
  • Abdominal pain
  • Suicidal feelings

Unfortunately, people don’t always get sick during office hours.  If your symptoms are not serious or life-threatening, try to contact your doctor first. If your doctor is not in the office, our Oxford plan has registered nurses who offer healthcare guidance around the clock, 24 hours a day, seven days a week.  For assistance, call 1-800-201-4911.

The Oxford On-call nurse can offer suggestions and guide you to the most appropriate source of care. There are also numerous Urgent Care Centers available to Oxford members.

2. Take Advantage of Urgent Care Centers   When You Have a Non-life-threatening Injury or Illness

Urgent Care Centers treat patients who have an injury or illness that requires immediate care but is not usually serious enough to require a visit to an emergency room. Urgent Care Centers are walk-in medical centers where you will be seen without an appointment.  They are typically open seven days a week with extended hours. They are dedicated to providing you high-quality medical care in situations when you need it the most. Urgent Care Centers minimize the wait times usually encountered in the ER and work with primary care physicians to provide care when your doctor is unable to see you.

Using Urgent Care Centers saves you money and time. A trip to the ER will likely cost you more since there are higher co-payments for ER visits. Your visit to an Urgent Care Center is treated as a specialist office visit, and you will pay your specialist co-pay instead of the higher emergency room copayment under your Oxford plan.  Urgent Care Centers offer quicker, high-quality care at a lower cost. Most Urgent Care Centers have on site lab services, x-rays, and pharmacy, and have extended hours seven days a week. For a minor illness or injury that needs immediate medical attention, an Urgent Care Center is your better option.

You can search for an in-network urgent care facility on the Oxfordhealth.com web site, or by calling the phone number on the back of your ID card.  Find out where the nearest urgent care facility is located right now, before you need it.

When should you go to an Urgent Care Center?

  • You can’t get a timely appointment with your physician
  • You do not have time to wait in a hospital emergency room
  • Your regular clinic is closed or your physician is on vacation.
  • When your injury or illness is urgent, but not life-threatening.

Conditions that can be treated in an Urgent Care setting may include:

  • Minor injuries
  • Minor Lacerations
  • Eye redness or irritation
  • Minor fractures (fingers, toes)
  • Urinary tract infections
  • Upper respiratory tract infections
  • Fever or flu
  • Sore throat
  • Skin rashes
  • Skin infections
  • Sprains and strains

Who will care for me?

Urgent Care Center physicians are board certified. Typical staff includes experienced physicians, physician assistants and nurse practitioners. Urgent Care Centers are equipped with a procedure room and diagnostic X-ray services. On-site pharmacy services and a blood drawing station with laboratory are also usually
available.

What happens after I leave urgent care?

You will be advised about all follow-up procedures and notified about any findings from laboratory work or X-rays. A complete record of your treatment will also be faxed to your primary care physician on request, who can provide any necessary follow-up care. If you do not have a primary care physician, we will help you find one in the area for follow up care.

3. Use Generic Drugs

Generic drugs, on average, cost one-third less than brand name drugs but use the same active ingredients and have the same therapeutic benefit. The next time your doctor gives you a prescription for a brand name medication, ask if a generic equivalent is available and if it might be appropriate for you. While there are exceptions, generic medications are usually your lowest cost option. Please note that some generic medications may be in Tier 2 or Tier 3 and will not have the lowest copayment available under your pharmacy benefit plan. Go to www.oxfordhealth.com or refer to your Summary of Benefits to determine the copayment for your generic medication.

4. Use Oxford’s Mail-Order Program for Maintenance and Long-Term Medications

Our mail order program provides a convenient and cost-effective way for members whose plan includes the mail order prescription benefit to order up to a 90-day supply of medications you take on an ongoing basis, such as those used to treat chronic conditions like high blood pressure or diabetes. Using this program, you can obtain a three month supply of a drug for the cost of only two co-payments.

If you have any questions regarding our retail pharmacy or mail order program, please contact our Pharmacy Customer Service line at 800-905-0201 24 hours a day, seven days a week.

5. Take Your Medications As Prescribed

A phenomenon--referred to as “prescription non-adherence”--has been documented in various studies. Many patients diagnosed with chronic conditions are failing to get their initial medication prescriptions filled.  Others start out taking their medications as prescribed, but within 90 days to 180 days of their initial prescriptions, they cut back on or completely stop taking their medications. Some simply forget, while others are unhappy about the medications’ side effects or find the prescription co-pays too burdensome.

Non-adherence represents a major medical expense. A report issued last month by Express Scripts, a pharmacy-benefit-management firm, estimated that non-adherence costs the economy $163 billion per year in additional medical expenses and lost productivity. Diabetics who are lax about taking their medications, for example, cost an average of $25,000 per year in medical expenses, while those who adhere to their treatments cost an average of $9,000 annually.

Patients who are compliant with their prescription regimen may generate higher Plan prescription costs, but they will generate much lower medical expenses.  

6. Check Your EOBs to Make Sure They Only Include Services You’ve Received

On the Oxfordhealth.com member web site, members can view a claim, check benefits, search for a physician, refill a prescription, and perform a host of other transactions.  Members can also view and print the Explanation of Benefits (EOB) form associated with each claim.  Carefully review the EOB forms to make sure they only include services you received.  Call Oxford Member services at 1-888-201-3080 or the United Welfare Fund’s Member Services Department at (718) 658-4848 if you find a mistake.

7. Know When to Stay Home and Treat Your Aches  on Your Own

Don’t see a doctor for largely untreatable ailments such as cold, upset stomachs, or occasional fatigue. All you’ll get is reassurance to do what you’re already doing: stay home, rest, drink plenty of fluids, and take aspirin. If you have questions about how to treat yourself, call an Oxford On-call nurse 24 hours a day, seven days a week at 1-800-201-4911. However, if these symptoms persist, see a doctor.

8. Visit In-network Doctors

Oxford/UnitedHealthcare negotiates with providers and healthcare facilities for discounted fees. These providers make up the health plan’s network, and the negotiated discounts can be substantial. When you visit an in-network provider, you usually pay a lower copayment, lower deductible and lower coinsurance (depending on your plan). Some of our Oxford plans require that you use in-network providers exclusively (no out-of-network benefits). Visiting an out-of-network provider can cost you plenty.

Getting information about a doctor or hospital can be difficult. That’s why providing members with important tools and data that give them greater access to information about quality and cost-effective care is one of Oxford/UnitedHealthcare’s priorities. The UnitedHealth Premium® designation program is a physician performance assessment initiative that evaluates network physicians based on national standards established by medical specialty societies. Physicians are evaluated for quality of care and their fees are measured against local benchmarks for cost efficiency. To search for a UnitedHealth Premium® designated provider, please visit www.Oxfordhealth.com and under the search for a doctor option, select “yes” from the drop-down box next to “UnitedHealth Premium® Providers?”

9. Save on Duplicate Test Costs

If you want a second opinion, ask your doctor to send copies of your medical records, x-rays, and lab tests to the second-opinion doctor. These tests don’t need duplication; your second doctor will have the information he or she needs, you won’t have to go through the tests again, and the Plan won’t have to pay double.

10. Live a Healthier Lifestyle

Ok, we just had to say it. Fulfill your New Year’s resolutions to exercise more, eliminate stress, stop smoking, get plenty of rest, get regular check-ups, drink 8 glasses of water a day, avoid red meat, and eat lots of fruits, vegetables and fish. 

We all know that good health starts with prevention. Whatever a member’s health status is, Oxford provides a wealth of information and resources to help you take an active role in your health. There is a wide array of wellness and preventive resources at no charge to members available on Oxford’s website: www.Oxfordhealth.com.

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