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Enroll and get quotes with Oscar - No extra charge for broker support

VIDEO Instructions on how to
#ENROLL  ONLINE   direct,
Quotes & Enroll  Covered CA

Oscar’s Focus

Oscar’s Health Insurance focuses centers around the Internet and mobile applications. Another click and appointment options — a free doctor’s call or a visit to a primary care physician or specialist — are splashed on the screen with estimated costs. A consumer could expect to shell out a total of $200 in co-pays and typical prescriptions or tests for a visit to a specialist. Oscar offers an Exclusive Provider Organization plan, or EPO — a hybrid of the HMO and PPO models. Consumers, for example, receive no coverage out of network, but unlike an HMO they don’t need a primary care physician or a referral to see a specialist.   Providence Health & Services,  UCLA Health, St Joseph, HOAG, Huntington Memorial and USC Keck have signed on to Oscar’s network, giving it 19 hospitals and 11,000 MD’s in Los Angeles.  Orange County has 9 hospitals and 5,000 providers.

All plans are EPOs 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.

Classic plans

Classic plans have higher monthly premiums and lower annual deductibles than Simple plans. Most plans provide pre-deductible copays for routine care and drugs. All plans have either coinsurance or affordable copays after you hit your deductible.

Saver plans
(Non Standard)

Saver plans are low premium, high deductible plans. In California, these are plans that work alongside a Health Savings Account (HSA). With HSA compatible Saver plans, you pay the full negotiated rate for care out of your HSA until your reach your deductible. After that, Oscar pays 100% for any covered care.

Oscar’s Simple Plans
(Non Standard)

offer something different, they combine the deductible and Out of Pocket Maximum as one number.  The kicker, you still get pre-deductible benefits.  For example, you have a $4,500 deductible and MOOP on the Gold Simple plan, however you can go to the doctor, get your labs and x-rays all at a flat co-pay prior to meeting your deductible.  Simple!

 

In 2021  Oscar paid a lot of claims!  Their MLR Medical Loss Ratio was 99.7% !  Modern Health Care *  Yahoo Covered CACMS.govFierce Health Care

Enroll and get quotes with Oscar - No extra charge for broker support

VIDEO Instructions on how to
#ENROLL  ONLINE   direct,
Quotes & Enroll  Covered CA

#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 *

 

OSCAR #TeleMed

This is our "Main Module" 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 websitemobile application, and their  customer service line  1-855-672-2755.

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
  • I checked with Oscar and their Tel Med is just for an initial visit.
  • Here's what I googled for online therapists. Check with them and ask what Insurance Plans they take. Then double check on the official Insurance Company provider list.
    • http://www.apa.org/helpcenter/online-therapy.aspx
    • https://www.talkspace.com/
    • https://amwell.com/cm/services/online-therapy/

    •  

      https://www.livehealthonline.com/psychology

2 comments on “Oscar Health Insurance

  1. Hi, Steve.
    Thanks, I’m all set with Oscar. I received a welcome letter and found instructions on making a web payment for my EPO 87 plan for Jan 1, 2018.

    I also set up the auto-pay recurring payments as well.

    Thanks for your help with the ACA insurance stuff here. Bye bye to Blue Shield of Calif. Their rates for the same PPO enhanced silver insurance were ridiculous.

    Oscar is a newer, startup company, so the competition for business is exactly what President Obama and Congress intended when they set up the ACA, among many other patient protections for those of us with pre-existing conditions.

    Thank you again,

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