Capital Health System'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. Despite good faith efforts to negotiate a new agreement, mental health and substance abuse services under our current contract with Capital Health Regional Medical Center in Trenton, NJ and Capital Health Medical Center - Hopewell in Pennington, NJ (Capital Health System) will be considered out-of-network for Oxford members¹effective February 1, 2012.
 

Capital Health Systemremains participating (in-network) for all other services.

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

·         Oxford members may continue to access Capital Health System for mental health and substance abuse services until February 1, 2012.

• Capital Health System stillmay be used for emergency services.²
• Inpatient and outpatient mental health and substance abuse hospital services provided at a Capital Health System hospital 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:
  • If Oxford expressly authorizes or approves a member to receive mental health services at a Capital Health System hospital (Note that this is not required for substance abuse services.)
• We will have Transitional Care guidelines in place so members who have scheduled or ongoing treatments at a Capital Health System hospital will continue to get care as appropriate.³

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.

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, www.oxfordhealth.com by clicking on the search for an Oxford doctor, hospital or lab link below Get to Know Oxford.
 

We are sending communications to our employer groups and members who may be affected should Capital Health System no longer participate in the Oxford network for mental health and substance abuse services. To view samples of these communications, please click the links below.

Sample Oxford Employer Letter
Sample Oxford Member Letter
 

We will continue to work toward a positive outcome of affordable health care for your clients and their employees and will keep you informed on the status of negotiations. If you would like more information, please contact your sales representative.