• Report: #175223

Complaint Review: Oxford Medicare Advantage

  • Submitted: Tue, February 07, 2006
  • Updated: Sat, June 09, 2007

  • Reported By:no comment New York
Oxford Medicare Advantage
Monroe, Connecticut U.S.A.

Oxford Medicare Advantage ripoff bait and switch scam Monroe Connecticut

*Consumer Suggestion: Your death and mine willsolve our problems our children too

*Consumer Comment: To Laura from Saint Louis, Missouri

*Consumer Suggestion: Costs are rising.

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Below is a copy of a letter sent to Oxford's Special Investigations Unit.

Oxford HealthPlans
Special Investigations Unit
Monroe, CT 06468

Sir or Madam:

[The below definition is taken from Oxford's web site]

What is healthcare fraud?

Healthcare fraud is the intentional deception or misrepresentation of healthcare transactions by a provider, employer group, or member for the sake of receiving an unauthorized benefit or financial gain. Individuals convicted of this crime face imprisonment and substantial fines.

You left one entity out of your definition: The Healthcare organization itself. Following is a summary of the bait and switch tactics used by Oxford's unscrupulous leadership.

In the spring and early summer of 2005, Oxford saw an opportunity in Orange County, New York to swoop down and prey upon a vast sea of potential Medicare recipients that have been denied any form of zero dollar premium supplemental medical insurance. The only thing available to these elderly retirees and disabled people, who were not privy to the special arrangements offered by Medicare to Health Care Insurance companies for those who lived in New York City, was Medicare alone, which with its high co-payments, and lack of sufficient coverage, was designed to eliminate as many of them as possible from the rolls of Social Security.

Medicare alone slowly drains what little resources they have until in desperation they are forced to forego any needed medical attention in favor of basic survival. Nevertheless, fear not, for to the rescue comes Oxford's Medicare Advantage program, I wonder whose advantage Oxford was thinking of, to save the day. Let us see:

1) $10.00 PCP copay
2) $20.00 Specialist copay

3) $80.00 per day not to exceed $800.00 per hospital stay

4) $100.00 Ambulatory facility copay

5) $0.00 copay for X-Ray, CAT scan, and MRI Services
6) $0.00 copay for Ambulance Services

7) $20.00 copay for urgently needed care


1) $15.00 PCP copay
2) $25.00 Specialist copay

3) $125.00 per day not to exceed $1500.00 per hospital stay
plus a $250.00 in-patient physician copay

4) $300.00 Ambulatory facility copay plus a $200.00 outpatient
physician copay

5) 20% copay for X-Ray, CAT scan, and MRI Services
(Original Medicare copayment)

6) 20% copay for Ambulance Services
(Original Medicare copayment)

7) $25.00 copay for urgently needed care

Therefore, as you can see, for these people on a fixed income, the difference between some of the benefits in 2005 as compared to the same benefits in 2006 is overwhelming!

An $800.00 hospital stay in 2005 has now morphed into a $1750.00 expense in 2006!

Likewise, a $100.00 outpatient facility copayment has now escalated to a whopping $500.00!

Oxford now leaves the payment of all X-Rays, MRIs, CAT scans, and Ambulance services to Medicare with the policyholder now being charged 20%, the original Medicare copayment. One might well ask, what the hell does Oxford pay!

Oxford sent their bait and switch representative Gary Summers, who like a good little employee, denied Oxford's past bad reputation, into Orange county, New York. His mission was to sucker the unsuspecting and the needy into Oxford's Medicare Advantage plan. It turns out Oxford's true intent was to enlist as many people as it could into their fold and then upon the new year, fleece them!

I realize that Oxford designs its policies to act as algorithmic programs to solve it's never-ending problem: How to screw as many people as possible while claiming to help them in their time of need and at the same time take in as much money as possible while paying out as little as it can.

One way in which Oxford solves this dilemma is to make its co-payments so high that the majority of those covered cannot afford to pay them thereby limiting the disposition of their claims to the most meager of payouts.

In other words, all Oxford, or any other Insurance company for that matter, wants is free money!

Those, like the leadership of Oxford, who are in control, and having no conscience, play their deadly games of greed and power while exploiting and manipulating those in need like Medicare beneficiaries without any misgivings or regard for morality are the truly fraudulent!

I call for the Special Investigation of Oxford itself!

Fed up!

no comment, New York

This report was posted on Ripoff Report on 02/07/2006 06:34 PM and is a permanent record located here: http://www.ripoffreport.com/r/Oxford-Medicare-Advantage/Monroe-Connecticut-06468/Oxford-Medicare-Advantage-ripoff-bait-and-switch-scam-Monroe-Connecticut-175223. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.

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Updates & Rebuttals

#1 Consumer Suggestion

Your death and mine willsolve our problems our children too

AUTHOR: Kimberly - (U.S.A.)

First of allchilld molesters control the world . Second of allnthencost of Xrays is no concern to DCF who advertised the policy and or to police agency no concerns its thecost to feed you in prison your food costs cantsee these private doctors not your money its the feds. Are no XRAYS GET NONE I NEVER DID insured by travelersn since age 2. Be no xrays. Old ads that belong in an1920 is the year old and fraudulent aboutwhat they will cover. at all at the us department of corrections. Bullets for chid molesters to shoot you child inthenface with cost cocaine is costly to them also it just says this in DCF ads. Dont mean it at all none ofits true.You have no rights to food in any hospital wont ever feel good ads are not true. You can work out in prison on those machineswith our employees sexually this costs alluntrue been untrue at the medicare.govis all untrue whatevernchildmolesters need what the ads need to state sheriffs too phillip Williams is one of them his ads are not happeningnever did never goingto happennin the usa.
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#2 Consumer Comment

To Laura from Saint Louis, Missouri

AUTHOR: Fedup - (U.S.A.)

To Laura:

The increases to member co-payments and decreases in member benefits that Oxford initiated in January 2006 were drastic changes, not reasonable or affordable to those on fixed incomes. While all the Big Boys were deciding how much to increase what they take in and decrease what they give out they also factored in the percentage of their members that would not be able to afford their demands, justified or not, and forego needed medical treatment. This percentage translates into higher revenues with which to fill their coffers and their pockets.

Those who control the lives of others institute their plans with robotic insensitivity while at the same time crying hardship and seeking sympathy offering the same tired excuses they have used for generations. Yet, their economic control of each generation continues to grow and their personal pockets protrude with legal tender that all to fleetingly passes through the hands of those in need.

Go back in generational time and review the gross amounts of money taken from them and compare those figures with the gross amounts of monies taken from the present generation. You will find that those who control are never satisfied! We have now entered the Generation of Trillions. How long will this last? Not long, I think. The next generation, holding true with the Law of Generations, will be greedier than its predecessor and quickly usher in the Generation of Quadrillions. No doubt still using a shortage of and increased operating costs as their justification.

They have conditioned society to accept and never question anything they do. If you ask why has this price increased or question their response to the conditioned, they act as if the one who questioned their motives is crazy and label that person as a troublemaker! They hire mostly those under the influence of their conditioning. Remember, slavery was never abolished; it was expanded to include the rest of society!

Why do you think they first initiated credit cards? They were forging ahead preparing the way for their continual rate and price increases. They knew their coming invasion of greed would lead to vast poverty so to offset the nil effect they sold people the use of money at loan Shark interest rates.

Look at the way society has been affected by their greedy behavior. Its family and moral fabric has been eroded because in most cases both parents are employed, in debt, and barely able provide healthy living conditions. Children are shuffled of to Daycare Centers for which a hefty price must be paid. Family dinners amount to little more than a quick stopover at the non-nutritional fast food joint or some pre-packaged unknown of inferior quality.

What you must understand is that the domino effect justified by increased operating costs, is an excuse, not a reason! By using the conditioning technique known as common knowledge, they have been able to fortify the concept of increased operating costs along with the concept of annual rate and price increases to such an extent that these are now stoically accepted, expected, and firmly implanted within the engrams of the public.

We have only scratched the surface of the deception and conditioning perpetrated against the society by these people. Think about these questions: What does a bank really do for its customers? What benefits are derived for you when handing your money over to them?

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#3 Consumer Suggestion

Costs are rising.

AUTHOR: Laura - (U.S.A.)

This is not unfamiliar, I myself as an insured and working in the insurance industry.

The costs are rising, copays rise, out of pocket amounts rise. How Medicare and a secondary and supplemental policy coordinate benefits are different.

Jack with company a...company a chooses to select a standard COB(coordination of benefits),Medicare as primary , the insurance would consider the 20% medicare did not pay on after deductible or any co-insurance that might be on the plan.

Sylvia with company b is a retiree with carve out cob, if medicare exceeds or meets what the insurance would pay as primary then company b insurance would not pay until current year out of pocket is met (which could be 300,500, and even 2000 out of pocket)(OOP).

this is just an example of the impact of coordination of benefits and how policies differ.

Regardless of medicare if the Secondary Insurance policy has a Co-insurance or deductible the policy will not pick up any amounts until this is satified. Supplemental policies are designed to just pick up 20%

Currently there are 3 types of COB (coordination of bene) Standard, Wrap-around and Carve Out.

Is Oxford a supplemental policy? or is this a Secondary Insurance? They are completely different. Secondary insurance is seen as a stand alone product and does not necessarily conform to automatic coinsideration of the 20% left over by medicare (eg. deductible, co-insurance)

Is the policy Self Funded, Minimally funded or Fully funded?

In my honest opinion it is not necessarily the bait and switch. Premiums change from year to year, if that means from going from 90/10 to 85/15, and truly for any plan who isn't necessarily a supplemental, it is to be expected that costs will rise and coverage will be minimal, and yes even at the cost of taking more from those on fixed incomes. I understand your frustration, dealing with a elderly grandparent, and with my own mother getting ready to hit retirment age. But the fact is, this is normal and not unusual. I agree it is a lot to stomach, understand and put up with. But if we want coverage sometimes we do have to pay more whether or not we can afford it. Until some changes occur, this is the norm. (even medicaid they will cut benefits in order to cover more individuals, and yes they have a "spend down", where they are responsible for an amount)

Just my humble 2 cents worth.
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