Montefiore Medical Center's Behavioral Health Participation

Montefiore Medical Center’s behavioral health participation in the Oxford network

We are committed to providing your clients and their employees with access to comprehensive and affordable health care services. Unfortunately, mental health and substance abuse services under our current contract with Montefiore Medical Center in Bronx, New York will be considered out-of-network for Oxford plan members effective Jan. 1, 2013.

Montefiore Medical Center remains participating for all other services.

When speaking to your clients, please keep in mind the following points:

. Oxford plan members may continue to access Montefiore Medical Center for mental health and substance abuse services until Jan. 1, 2013.

. Montefiore Medical Center may still be used for emergency services.1

. Inpatient and outpatient mental health and substance abuse hospital services provided at Montefiore Medical Center may be covered as out-of-network or denied (if clients do not offer out-of-network benefits). Higher deductibles and coinsurance may apply for those plans that have out-of-network benefits. Exceptions are as follows: o If Oxford expressly authorizes or approves a member to receive mental health and/or substance abuse services at Montefiore Medical Center. Authorizations provided prior to Jan. 1, 2013 for services on or after Jan. 1, 2013 will be honored provided Transitional Care has been granted. Additionally, no new authorizations will be granted for services to be provided on or after Jan. 1, 2013 unless Transitional Care has been granted.

. We will have Transitional Care guidelines in place so members who have scheduled or ongoing treatments at Montefiore Medical Center will continue to get care as appropriate.2

To receive services from a participating mental health and substance abuse provider, members should be referred to one of the major neighboring hospitals in our network, as listed below.

Neighboring Hospitals Hospital Location Bronx-Lebanon Hospital Center Bronx, NY Jacobi Medical Center Bronx, NY Lincoln Medical and Mental Health Center Bronx, NY North Central Bronx Hospital Bronx, NY Saint Barnabas Hospital Bronx, NY

1 When reviewing claims for emergency services, we may request medical records to confirm such services are emergency services. 2 This language refers to the Transitional Care benefits of New York members. Members who do not have a New York Plan should refer to the Transitional Care benefit described in their Certificate of Coverage.

To find additional participating hospitals, members can call Customer Service at the telephone number on their health plan ID card for assistance. Alternatively, they can search for one on our website, oxfordhealth.com, by clicking on the “search for a participating doctor, hospital or lab” link below “Get to Know Oxford.”

We are sending a letter to Oxford plan members who may be affected by Montefiore Medical Center no longer participating in the Oxford network for mental health and substance abuse services. To view a sample of the letter, please click the link below.

• Sample Oxford Member Letter

If you would like more information, please contact your sales representative.

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Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. Oxford HMO products are underwritten by Oxford Health Plans (NY), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc.

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