Oscar Health Insurance

Authorized Agent

#EPO vs HMO vs PPO?

EPO

All plans are EPOs Exclusive Provider Organization  with Doctor on Call, Concierge, and Step Rewards for staying active. Even better, Oscar never requires referrals to see a specialist. This means you don’t need to book an appointment with a primary care provider just to get a permission slip, saving you time and money.   See Page 5 of EOC Evidence of Coverage for more details. 

Choice of Physicians and Providers

This is an Exclusive Provider Organization (“EPO”) plan.

Services must be performed or supplies furnished by an In-Network Provider in order for benefits to be payable. Typically, there are no Benefits provided when using an Out-of-Network Provider and You may be responsible for the total amount billed by an Out-of-Network Provider. The only exceptions are:

● Services received by an Out-of-Network Provider as a result of a medical Emergency, Urgent Care Visit, or an Authorized Referral as defined in the
DEFINITIONS section; and
● Covered Services received at an In-Network Facility, at which, or as a result of which, the Member receives Covered Services from and Out-of-Network Provider. Authorized Referrals and Covered Services received under the second exception are provided at In-Network Cost Sharing.

To maximize Your benefits, be sure to confirm that the Provider (e.g. a Physician or Hospital) You wish to see is an In-Network Hospital or an In-Network Provider (for Providers other than Hospitals) under Your Plan. Services must be performed or supplies furnished by an In-Network Provider in order for benefits to be payable, unless one of the exceptions listed above apply.  ^{2020 EOC} *

• Health Net Definitions of HMO, PPO, EPO, etc. 
• Blue Cross Definition EPO
• Our webpage to explain deductibles, co-insurance, OOP – MOOP Out of Pocket maximum,

OSCAR #TeleMed

This is our "Main Page" on Telemed.  Not just Oscar but Telemed for ALL companies, in general.

Oscar covers Medically Necessary Covered Services offered through Telehealth by an In Network Provider subject to the terms and conditions of the their contracts with In Network Providers.   Telehealth Visits from certain Oscar-designated Telehealth Providers are covered in full.

Telehealth Visits can be requested through Oscar’s website, mobile application, and their  customer service line  1-855-672-2755.

• hioscar.com/doctor-on-call 
• Doctor On Demand.com
• hioscar.com/need-medical-advice-call-a-doctor-instead-of-your-mom
• EOC – Evidence of Coverage.
• Tele Med VIDEO Oscar
• OSCAR Tele Med 1 page flyer
• My CPA’s thoughts & research on Telehealth 
• U.S. saw significant drop in telehealth use last year after rapid growth in 2020 ^{Modern Health Care} *
• Telehealth Companies Want Congress to Make Pandemic Expansion of Their Services Permanent Time Magazine 4.2022 *

Further clarification from Oscar:

• Our Doctor on Call benefit is on all Oscar plans and include Oscar physicians that are board certified in your state.
• These physicians are not specialists, they generally are listed as Internal Medicine, Primary Care, etc.
• These doctors are not found on our website because there is no way to visit/select which doctor you speak to.
• The physicians often service multiple states, as they are generally certified in multiple.
• Personally, when I used the Doctor on Call benefit (at 11 pm) the doctor called me within 10 minutes.
• If I called again today I would likely be speaking to a different physician.
• I checked with Oscar circa 4.4.2019 and their Tel Med is just for an initial visit.  Check our Coronavirus page for updates on that.
• doctor on demand.com
• Emotional support helpline: 1-866-342-6892 – Optum
• AB 744 - TeleHealth 
• AB 744 will require contracts issued, amended or renewed after January 1, 2021 between a health care service plan and a health care provider to specify that the provider who delivers services appropriately through telehealth be reimbursed on the same basis and to the same extent that the plan would have had the same service been provided in-person.  The health plan cannot require the use of telehealth if the health care provider has determined that it is not appropriate nor does it limit the ability of the health plan and provider to negotiate the rate of reimbursement for a service. ^{TeleHealth Resources.org} *
• LA Times on Tele Med 8.2018

• telehealth is  the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

• Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.

• AMA outlines key steps for advancing telehealth equity
• Telehealth didn't lead to unnecessary care in 2020, study says  

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