onox ppu jan03

JANUARYInside: Congestive Heart Failure Monograph,

Chiropractic Benefit Update, and 2002 Clinical

Practice Guidelines for Anxiety Disorders

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OO X F O R D P R O V I D E R | P R O G R A M A N D P O L I C Y U P D A T E

Oxford Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Recently Approved Medical Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Revised Medical Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Chiropractic Benefit Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Oxford Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Congestive Heart Failure Monograph. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

eBusiness Updates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Information on Liberty PlanSM and Medicare Referrals . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Policy for Referrals Submitted after the Date of Service . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Claim Filing Deadlines for Participating Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Requesting a Confirmation of Claims Status Electronically . . . . . . . . . . . . . . . . . . . . . . . . 5

New Vendor Links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

HIPAA Compliant Eligibility Inquiry and Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Oxford Medicare AdvantageSM Program Updates . . . . . . . . . 62003 Oxford Medicare Advantage Member Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Radiology Program Updates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Policy Update for Nuclear Cardiology Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Policy Update for Nuclear Cardiology Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Pharmacy Program Updates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Claritin® Now Available Over-the-Counter Without a Prescription . . . . . . . . . . . . . . . . . 12

Merck-Medco Name Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

2003 Preferred Drug Formulary Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Prior Authorization Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

2002 Clinical Practice Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Detection, Diagnosis, and Treatment of Anxiety Disorders in Primary Care Setting . . 14

Oxford Participating Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

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OO X F O R D P R O V I D E R | P R O G R A M A N D P O L I C Y U P D A T E

In our ongoing effort toprovide the most prompt,correct information, we askthat you be prepared withyour Oxford Provider IDnumber when calling ourProvider Services Department.We will be able to access youraccount more quickly andprovide you with a moresatisfactory experience.

J A N U A R Y 2003

Oxford Policies

Issue Explanation

Medical Policy Medical policies can be requested by writing to:Policy Requests and InformationOxford Health Plans48 Monroe TurnpikeTrumbull, CT 06611

M & R and MCAP Criteria Please remember that these are proprietary services to which Oxfordsubscribes. Information on specific criteria can be requested by writing to:

Policy Requests and InformationOxford Health Plans48 Monroe TurnpikeTrumbull, CT 06611

Payment Policies Our payment policies are proprietary and cannot be distributed. For questions regarding claims payment, please call our Provider Services Department at 800-666-1353.

Requests for Fees To request information regarding fees, please call our Provider Services Department at 800-666-1353.

New Medical Technology Requests for review of new medical technology can be obtained by writing to:

New Medical TechnologyOxford Health Plans48 Monroe TurnpikeTrumbull, CT 06611

Recently Approved Medical PoliciesThe appearance of an item or procedure on this list only indicates that Oxford has recently adopteda policy; it does not imply that Oxford providescoverage for the item or procedure listed.

• Orthopedic Services for Commercial Plans

• Newborns

• Utilization Management Appeal Process and Time Frames for Pennsylvania Members

• Utilization Management Appeal Process and Time Frames for Delaware Members

• Disclosure Policy

• Pharmaceutical Treatment of Cosmetic Conditions

• Radiofrequency Ablation for Kidney Cancer

• Second Opinions

Revised Medical Policies • Autologous Chondrocyte Implantation (ACI)

for Knee Cartilage Defects

• Bone Growth Stimulation

• Orthotics

• Radiology Privileging List

• Wheelchairs, Power Operated Vehicles, and Specialized Strollers

• Fetal Reduction

• Inpatient Maternity Stay

• Member Administrative Grievance and Appeal(Non-utilization Management) Process and Time Frames for all Commercial Plans

• Hearing Tests for Newborns

2 www.oxfordhealth.com

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• Treatment of Infertility for ConnecticutCommercial Members

• Treatment of Infertility for New Jersey Large Groups

• Scelerotherapy

• Allergy and Clinical Immunology

• Vein Ligation and Stripping

• VNUS Closure and Restore Procedure for Varicose Veins and Venous Insufficiency

• Glucowatch Biographer System

• Endoluminal Gastroplication (Endocinch)Procedure for Treatment of GastroesophagealReflux Disease

• Intradiscal Eletrothermal Therapy

• Outpatient Pulmonary Rehabilitation

• Renova

• Bone Mass Measurements for CareCore

• Bone Mass Measurements for Non-CareCore

• Selection of a Primary Care Physician (PCP)

• Collagen Implants for Urinary Incontinence

• Radiofrequency Ablation for Liver Tumors

• Laparoscopic Uterosacral Nerve Ablation (LUNA)

• Fibrin Sealant for Treatment of Pre-termPremature Rupture of Membranes (PPROM)

• Wireless Capsule Endoscopy

• Yoked Prism Glasses

• Botox

• Proferrin for Dialysis Patients

• Circumcision

• Intraocular Lenses

• Multiple Sclerosis Drug Therapy

• Nasal and Sinus Surgery Including Rhinoplasty

• Reconstructive and Corrective Cosmetic Surgery

• Outpatient Diabetes Self-management and Education

• Growth Hormone Replacement Therapy

• Treatment of Obstructive Sleep Apnea

• Co-surgery/Team Surgery

• Outpatient Anesthesia Services for Dental/OralSurgical Procedures

• Pulse Oximeter

• Technical Reversals

Upon request, Oxford will provide a medical policy, including coverage guidelines and clinicalrequirements for coverage. Medical policies can be requested by writing to:

Oxford Health PlansAttn: Policy Requests and Information48 Monroe TurnpikeTrumbull, CT 06611

To request information regarding Oxford’s Quality Management Program, please write to:

Oxford Health PlansAttn: Quality Management Department44 South BroadwayWhite Plains, NY 10601

Chiropractic Benefit UpdateWe are pleased to announce that TRIAD Healthcare,Inc., a national network of chiropractors, has beenselected to administer all outpatient chiropracticservices for the majority of Oxford’s commercial andself-funded Members in Connecticut, New Jersey,and New York. It is Oxford and TRIAD’s commongoal to provide our Members with access to excellentchiropractic care.

Effective December 1, 2002, TRIAD administersOxford’s policies on chiropractic utilizationmanagement, claims processing (for specificMembers), and network management. Inaccordance with Oxford’s participation agreement, chiropractic providers must comply with the new utilization management policies

that are being implemented. For additionalinformation, please call TRIAD’s Network Services Department at 800-409-9081 or Oxford’sProvider Services Department at 800-666-1353.

Oxford Programs

Congestive Heart Failure Monograph According to the 2002 Heart and Stroke StatisticalUpdate produced by the American HeartAssociation, approximately 4,800,000 Americans are living with congestive heart failure (CHF) andeach year, over 550,000 new cases are diagnosed.Within the Oxford population, over 14,000Members have a congestive heart failure diagnosis.Oxford’s Heart Smart SM program is designed to help Members with CHF and cardiovascular disease(CVD) improve their health and quality of life.

In our efforts to deliver evidence-based practice toour network providers, Oxford has developed aneducational monograph, Managing the Heart FailureEpidemic. Topics covered include guidelines forchoosing and implementing ACE inhibition andbeta-blockade, patient education, and empowermentissues. To access the monograph, log in to “YourAccount” on www.oxfordhealth.com and downloadthe PDF from the CHF Monograph highlight.

For more information about the Heart Smartprogram, please call 877-759-3059, Monday through Saturday, between 8:30 AM and 8:30 PM.

If you would like to obtain a copy of ourManagement of Congestive Heart Failure guidelines,log in to your personalized account atwww.oxfordhealth.com. Next, click on Policies and Guidelines under the Business Center sectionand download the PDF. You can also request a copy by calling our Provider Services Department at 800-666-1353.

eBusiness Updates

Information on Liberty PlanSM

and Medicare ReferralsAs a reminder, physicians should not generate Oxford referrals for Liberty Plan or Oxford

Medicare Advantage Members who want to seeproviders who do not participate in the Member’sappropriate network, except in cases of medicalemergency or if there is no provider in the Libertyor Oxford Medicare Advantage network who canappropriately furnish the care required. Referralsmust be made appropriate to the Member’scoverage plan (i.e., a Liberty Member must bereferred to a Liberty Network provider; an OxfordMedicare Advantage Member must be referred to an Oxford Medicare Advantage network provider).The coverage plan is noted on the Member’s IDcard. Members who specifically ask for referrals to a provider who is not affiliated with their networkshould be directed to available participatingproviders who participate with the appropriatenetwork. If these Members self-refer to an Oxfordprovider who is not affiliated with their appropriatenetwork, please inform the Member of the following:

• If the Member does not have out-of-networkcoverage (HMO plan), the Member’s care will not be covered.

• If the Member does have out-of-network coverage(POS or PPO plan), the Member’s coverage issubject to deductible and coinsurance.

To locate a participating specialist, refer to theappropriate Oxford Roster of ParticipatingPhysicians and Providers or log in towww.oxfordhealth.com and use our advanced Doctor Search tool, being sure to select the network of the Member you are referring. If you do not have a roster or web access, please call ourProvider Services Department at 800-666-1353.

Policy for Referrals Submitted after the Date of ServiceAs a reminder, referrals should not be issued for services that have already been rendered.However, in instances where the Oxfordparticipating physician is administratively unable to submit a referral prior to the services beingrendered, we will allow referrals to be generated up to 72 hours after the services were rendered.Oxford reserves the right to monitor retroactivereferral generation and compliance of this policy.


Claim Filing Deadlines for Participating ProvidersAs a reminder, the deadline for filing a claim isbased on the date of service. It is not based on the date that the claim was sent to or received byOxford. The deadline for initial claims submission is 180 days from the date of service.

In order to appeal a denial for untimely filing, youmust be able to show proof of at least two attemptedsubmissions within the allowed 180-day filingperiod. Proof can include computer-generatedreports showing timeline of submissions, EDItransmission reports, or a previously submittedhardcopy of the claim that contains the submissiondate(s) on the bottom right-hand corner. The EDItransmission reports must be specific, indicating theinsurance carrier that the claim was submitted to,date of service, the services that were rendered andthe Member’s identification information. Pleasesubmit your appeals to:

Oxford Health PlansP.O. Box 7081Bridgeport, CT 06601-7081

Requesting a Confirmation of ClaimsStatus ElectronicallyDid you know you can request a fax confirmation of claims status electronically using our interactive voice response system, Oxford Express ®? Follow thesimple steps to receive a faxed confirmation within30 minutes.

To use Oxford Express to check the status of yourOxford claims, dial 800-666-1353 and press 3. Youwill need to provide the date of service, the patient’sOxford Member ID number (including the asterisk)or the patient’s Social Security number.

You can also obtain claims information by logging in to www.oxfordhealth.com. Once you are on your personalized provider home page, click on“Check Claims” in the left-hand navigation bar to look up claims information using any of the four search options.

The four claim inquiry search options include: • Search by multiple Member ID numbers or Social

Security numbers: Allows providers to enter up to 10 Oxford Member ID numbers or Social Securitynumbers to retrieve the last five claims on file for each patient associated with the authenticatedprovider. If more claims are on file, the “See Next5 Claims” link will bring up additional claims.

• Search by claim status: Allows providers to select aclaim status of “Paid,” “Denied,” “Received and inReview,” or “All,” and retrieve all of the claims onfile for the authenticated provider within a stated date range (up to one-month intervals).

• Search by CPT code: Allows providers to enter aspecific CPT code and retrieve all of the claims on file for the authenticated provider that containthat CPT code within a stated date range (up to one-month intervals).

• Search by check number: Allows providers to enter a specific check number and check date to retrieve all of the claims associated with thatOxford Remittance Advice.

New Vendor LinksTwo new vendor links were added to oxfordhealth.com.

Subimo™ Healthcare Advisor: • Provides consumers with comparisons of the

hospitals in which the procedures are performedand the conditions treated, as well as relevantinformation regarding specific conditions, diseases and medical procedures.

• Enables consumers to make healthcare decisionsbased on independent information.

• Supports Oxford’s efforts to promote increasedpatient safety.

ConsumerLab.com:• Provides independent test results and information

to help consumers and healthcare professionalsevaluate the safety of products such as vitamins,minerals, sport and energy products, foods and beverages.



• Publishes its test results online, including listingsof brands that have passed the tests.

• Allows consumers to view information on recallsand warnings, sign up for an e-mail newsletter, and access the Natural Pharmacist™ Encyclopedia.

All authenticated users can access the SubimoHealthcare Advisor and ConsumerLab.comthrough the oxfordhealth Center.

HIPAA Compliant Eligibility Inquiry and ResponseThe Health Insurance Portability and AccountabilityAct (HIPAA) of 1996, also known as the Kennedy-Kassebaum Act, is intended to assure the portabilityof health insurance, reduce healthcare fraud,guarantee the privacy and security of healthinformation, and standardize healthcare industrytransactions. We have been working to comply withthe requirements set forth by HIPAA and are pleasedto report that one of the first areas to become fullycompliant is our eligibility inquiry and response.During the first half of 2003, you will see changes to eligibility inquiry and response functionalitiesperformed through www.oxfordhealth.com, as well as through Oxford’s affiliated vendors (e.g., WebMD,Healthcare Data Exchange (HDX), and MedUnite).

Upcoming eligibility inquiry enhancements include:Ability to search by:

• Member ID number

• Member last name and Social Security number

• Member last name, first name, and date of birth

Improved response information including:

• Hospital emergency room copayment amount

• Hospital room and board information

• Specialist benefit information

If you have questions regarding these enhancementsor need assistance with web-related inquiries, pleasecall Oxford’s Team.Com at 800-811-0881 or yourelectronic data interchange (EDI) vendor directlyfor vendor inquiries.

Oxford MedicareAdvantage S M ProgramUpdates

2003 Oxford Medicare Advantage Member BenefitsEffective January 1, 2003, Oxford MedicareAdvantage is available in the following areas:

New York: Bronx, Kings, Queens, New York, and Richmond counties

New Jersey: Hudson County

Connecticut: New Haven County

2003 New York Oxford Medicare Advantage PlansEffective January 1, 2003, Oxford Health Plans willbe introducing a fourth Oxford Medicare Advantage(OMA) plan, Oxford Medicare Advantage BalanceSM.The majority of the benefits being offered in ourthree existing Oxford Medicare Advantage plans —Oxford Medicare Advantage Essential,SM OxfordMedicare Advantage SignatureSM and OxfordMedicare Advantage PlusSM — will remain the samein 2003. We have provided an overview of the fourOxford Medicare Advantage plans being offered inNew York in 2003 for your quick reference.

Oxford Medicare Advantage Signature(Formerly known as Oxford Medicare Advantage)The 2003 Oxford Medicare Advantage Signatureplan is available in Bronx, Kings (Brooklyn), New York (Manhattan), Richmond (Staten Island)and Queens counties in New York. The followingchart compares the 2003 OMA Signature benefits to the plan benefits offered in 2002.


Benefit 2002 2003

Monthly plan premium $0 $0 (no change from 2002)

Primary care physician copayment $15 $15 (no change from 2002)

Specialist copayment $25 $25 (no change from 2002)

Generic drug annual limit Unlimited Unlimited (no change from 2002)

Generic drug cost share $10 The greater of (i) $15 and (ii) 50% of the total cost1 of the covered drug.2

Combined preferred and non-preferred brand drug annual limit $750 $500

Preferred brand drug cost share $25 The greater of (i) $25 and (ii) 50% of the total cost1 of the covered drug2

Non-preferred brand drug cost share $50 The greater of (i) $50 and (ii) 50% of the total cost of the covered drug2

Inpatient hospital facility copayment $500 per benefit period3 $500 per benefit period3

(no change from 2002)

Inpatient hospital surgery copayment $150 $150 (no change from 2002)

Ambulatory surgery facility copayment $200 $200 (no change from 2002)

Ambulatory surgery physician copayment $75 $75 (no change from 2002)1 The total cost of the covered drug will reflect Oxford’s discounted rates, plus a prescription dispensing fee, minus an average per-drug forecast of the pharmacy rebatesOxford expects to receive for formulary drugs.

2 If the total cost of the covered drug is less than $15 for generic drugs, $25 for preferred brand drugs, or $50 for non-preferred brand drugs, the Member pays the totalcost of the covered drug.

3 A benefit period begins the first day the Member is admitted to a hospital or skilled nursing facility.The benefit period ends when the Member has not received hospitalor skilled nursing facility care for 60 consecutive days. If the Member is admitted to a hospital after one benefit period has ended, a new benefit period begins.TheMember must pay the inpatient hospital deductible for each new benefit period.There is no limit on the number of benefit periods a Member can have.

Oxford Medicare Advantage Balance The new OMA Balance plan offers benefits similar to the OMA Signature plan; however, the OMA Balanceplan includes a $1,000 deductible and eliminates the inpatient and outpatient copayments. The 2003 OxfordMedicare Advantage Balance plan is available in Kings (Brooklyn), New York (Manhattan), Richmond(Staten Island) and Queens counties in New York (the OMA Balance plan is not offered in Bronx County).The following chart highlights some of the benefits of the OMA Balance plan.

Benefit 2003

Monthly plan premium $0

Primary care physician copayment $5

Specialist copayment $10

Generic drug annual limit Unlimited

Generic drug cost share The greater of (i) $15 and (ii) 50% of the total cost1

of the covered drug2

Combined preferred and non-preferred brand drug annual limit $500


The $1,000 deductible does not apply to:

• Physician office visits

• Wellness visits (preventive care)

• Urgent care

• Emergency room

• Immunizations

• Allergy testing and treatment

• Occupational therapy

• Speech therapy

• Physical therapy

• Chiropractic services

• Radiology services

• In-office surgery

• Additional Oxford benefits and services (hearing,vision, podiatry visits, nutrition visits, exercise andfitness classes, worldwide emergency care, non-Medicare covered drugs, and dental services)

Oxford Medicare Advantage Balance (continued)

Benefit 2003

Preferred brand drug cost share The greater of (i) $25 and (ii) 50% of the total cost1


Non-preferred brand drug cost share The greater of (i) $50 and (ii) 50% of the total cost1


Inpatient hospital facility copayment $0*

Inpatient hospital surgery copayment $0*

Ambulatory surgery facility copayment $0*

Ambulatory surgery physician copayment $0*

* The Member is responsible for paying for the first $1,000 of the costs associated with certain services such as inpatient and outpatient hospital care.There are no additional copayments for services applied toward the deductible. For those services, the Member will not be responsible for additional costs beyond the$1,000 deductible.

1 The total cost of the covered drug will reflect Oxford’s discounted rates, plus a prescription dispensing fee, minus an average per-drug forecast of the pharmacy rebates Oxford expects to receive for formulary drugs.

2 If the total cost of the covered drug is less than $15 for generic drugs, $25 for preferred brand drugs, or $50 for non-preferred brand drugs, the Member pays the total cost of the covered drug.

Please note: Copayments may apply to some of the benefits listed above.

Oxford Medicare Advantage EssentialOxford introduced this plan in August 2001 to meet the needs of those individuals who do not want to pay acopayment for services such as inpatient and outpatient hospital care and those who may not require brandname prescription drug coverage or have brand name prescription drug coverage through other sources suchas the Elderly Pharmacy Insurance Program (EPIC). The 2003 OMA Essential plan is available in Bronx,Kings (Brooklyn), New York (Manhattan), Richmond (Staten Island) and Queens counties in New York. The following chart compares the 2003 OMA Essential benefits to the plan benefits offered in 2002.


Benefit 2002 2003





Generic drug cost share $10 The greater of (i) $15 and (ii) 50% ofthe total cost1 of the covered drug2

Combined preferred and non-preferred brand drug annual limit None None (no change from 2002)

Inpatient hospital facility copayment $0 $0 (no change from 2002)



Ambulatory surgery physician copayment $0 $0 (no change from 2002)

Oxford Medicare Advantage PlusThe Oxford Medicare Advantage Plus plan provides Members with the freedom to see providers outside theOxford network and still receive coverage. The 2003 OMA Plus plan is available in Bronx, Kings (Brooklyn),New York (Manhattan), Richmond (Staten Island) and Queens counties in New York. The following chartcompares the 2003 OMA Plus benefits to the plan benefits offered in 2002.

Benefit 2002 2003

Monthly plan premium $110 $125




Generic drug cost share $10 The greater of (i) $15 and (ii) 50% ofthe total cost1 of the covered drug2

Combined preferred and non- $1,000 $750preferred drug annual limit

Preferred brand drug cost share $15 The greater of (i) $25 and (ii) 50% ofthe total cost1 of the covered drug2

Non-preferred brand drug cost share $50 The greater of (i) $50 and (ii) 50% ofthe total cost1 of the covered drug2





Ambulatory surgery physician copayment $75 $75 (no change from 2002)

1 The total cost of the covered drug will reflect Oxford’s discounted rates, plus a prescription dispensing fee, minus an average per-drug forecast of the pharmacyrebates Oxford expects to receive for formulary drugs.


2 If the total cost of the covered drug is less than $15 for generic drugs, $25 for preferred brand drugs, or $50 for non-preferred brand drugs, the Member pays the total cost of the covered drug.

3 A benefit period begins the first day the Member is admitted to a hospital or skilled nursing facility.The benefit period ends when the Member has not receivedhospital or skilled nursing facility care for 60 consecutive days. If the Member is admitted to a hospital after one benefit period has ended, a new benefit period begins.The Member must pay the inpatient hospital deductible for each new benefit period.There is no limit on the number of benefit periods a Member can have.

The following chart compares the 2003 OMA Plus out-of-network coverage to the out-of-network coverageoffered in 2002. This benefit applies to care provided by non-participating providers. Please note: Medically necessary, worldwide emergency care does not apply toward the out-of-network benefit.

Out-of-Network Benefit 2002 2003

Out-of-network deductible $200 per calendar year $200 per calendar year (no change from 2002)

Out-of-network coinsurance 15% – once the deductible is met 15% – once the deductible is met(no change from 2002)

Out-of-network maximum $50,000 per calendar year $500,000 per calendar year

Referrals Not required for care provided Not required for care provided by non-participating providers by non-participating providers


Precertification Member must call Oxford for Member must call Oxford forauthorization of all out-of-network authorization of all out-of-networkcare requiring precertification care requiring precertification


Additional Benefits Offered by New York OMA Plans

Benefit Benefit Description

Standard Vision $50 reimbursement for an eye exam provided by any optometrist or ophthalmologistonce every 12 months and $70 reimbursement for eyeglasses or contact lenses onceevery 24 months. PCP referral is not required.

Enhanced Vision Services must be provided by a Davis Vision provider. One vision exam once every 12 months at no charge and one set of eyeglasses or contact lenses once every 24 months at no charge. PCP referral is required.

Standard Hearing One hearing exam provided by an Oxford affiliated audiologist once every 12 months; specialist copayment applies. PCP referral is required. $300reimbursement for a hearing aid purchased from any supplier once every 36 months.

Enhanced Hearing Services must be provided at a HearX Center. One hearing exam every 12 months at no charge and a $700 discount toward a hearing aid once every 36 months. PCP referral is not required.

Podiatry Receive four (one per quarter) routine visits (cutting or scraping of nails) at nocharge. PCP referral is not required.


Radiology ProgramUpdates

Policy Update for Nuclear Cardiology Providers Effective February 2, 2004, all nuclear cardiologyproviders interpreting nuclear cardiologyexaminations will be required to meet one of the following standards in order to receivereimbursement for nuclear cardiology claims:

• Accredition by the Certification Board for Nuclear Cardiology (CBNC)

• Board certification in Nuclear Medicine by theAmerican Board of Nuclear Medicine (ABNM)

• Board certification in Radiology by the AmericanBoard of Radiology (ABR)

If you are currently accredited or certified by the CBNC, ABNM, or ABR, or upon receipt ofaccreditation or certification, please fax yourcertificate to the attention of our AccreditationCredentialing Department at 914-467-4605.

Additional Benefits Offered by New York OMA Plans (continued)

Benefit Benefit Description

Dental Care Preventive and diagnostic dental care provided by an Oxford participating primarycare dentist at no charge. Basic and major dental services provided by an Oxfordparticipating dental provider are provided at a discounted rate negotiated by Oxford.

Nutrition Preventive nutrition consultation every 12 months at no charge. PCP referral notrequired. If necessary, one intervention and one follow-up visit every 12 months. A specialist copayment applies per visit. PCP referral is required.

Fitness Basic gym membership including all amenities at participating fitness facilities at no charge. PCP authorization may be required.

2003 New Jersey and Connecticut Oxford Medicare Advantage PlansMedicare beneficiaries who reside in Hudson County, New Jersey, and New Haven County, Connecticut, are offered identical plans. The chart below compares the 2003 OMA benefits available in Hudson County,New Jersey, and New Haven County, Connecticut, to the plan benefits offered in 2002.

Benefit 2002 2003




Prescription drug benefit None None (no change from 2002)


Inpatient hospital surgery copayment $150 $200

Ambulatory surgery facility copayment $200 $250

Ambulatory surgery physician copayment $75 $100

1 A benefit period begins the first day the Member is admitted to a hospital or skilled nursing facility.The benefit period ends when the Member has not received hospitalor skilled nursing facility care for 60 consecutive days. If the Member is admitted to a hospital after one benefit period has ended, a new benefit period begins.The Member must pay the inpatient hospital deductible for each new benefit period.There is no limit on the number of benefit periods a Member can have.


Policy Update for Nuclear Cardiology Facilities Effective February 2, 2004, all nuclear cardiologyfacilities must be accredited by either theIntersocietal Commission for the Accreditation of Nuclear Laboratories (ICANL) or the AmericanCollege of Radiology (ACR) in order to receivereimbursement for nuclear cardiology claims.

If your facility is currently accredited by the ICANL orthe ACR, or upon receipt of accreditation, please faxthe certificate to the attention of our AccreditationCredentialing Department at 914-467-4605.

Pharmacy ProgramUpdates

Claritin® Now Available Over-the-CounterWithout a PrescriptionThe Food and Drug Administration (FDA) recentlyapproved the over-the-counter (OTC) sale of all five formulations of Schering Plough’s Claritin(loratadine) at the original prescription strengths asnonprescription medications. This drug is used forthe treatment of allergic rhinitis. Claritin, previouslyavailable only as a prescription drug, is the first non-sedating antihistamine to be available without a prescription. Claritin OTC became available thispast December. Generic loratadine products bymanufacturers other than Schering Plough are also expected to become available. The FDA isexpected to approve Claritin OTC for generalitching and chronic idiopathic uritcaria indicationsin early 2003. As Claritin is now available without aprescription, coverage will no longer be providedthrough Oxford’s prescription drug benefit.

Merck-Medco Name ChangeMerck-Medco Managed Care, L.L.C., has changed itsname to Medco Health Solutions, Inc., effective July1, 2002. Please note that it may take several monthsfor Medco Health to complete the transition, so youmay receive some materials that still include theMerck-Medco name. Medco Health administersOxford’s retail and mail-order pharmacy benefits.The mail-order benefit provides eligible OxfordMembers with a convenient way to receive up to a 90-day supply of certain maintenance prescriptionmedications. Medco Health also offers accessibility to

a national pharmacy network of 50,000 participatingretail pharmacies and 24-hour customer service.

Pharmacy Customer Service: 800-905-0201 (24 hours a day, seven days a week — exceptThanksgiving and Christmas)

Medco Health Prior Authorization Service:800-753-2851 (Monday through Friday, from 8 AM to 9 PM)

2003 Preferred Drug Formulary UpdateFor Members with a three-tier prescription drugbenefit, preferred brand drugs, as designated on the Preferred Drug List, carry a lower copaymentthan non-preferred brand drugs. The PreferredDrug List for this benefit was designed by ourClinical Pharmacy and Therapeutics (P&T)Committee to promote medically appropriate, cost-effective healthcare while preserving yourability to prescribe specific agents of choice for your patients. We invite your comments and willconsider them when updating the formulary as new drugs are introduced and new indications are described for existing drugs.

The three tiers of this benefit include generic drugs(tier 1), preferred brand drugs (tier 2), and non-preferredbrand drugs (tier 3), with an increase in copaymentto our Members with each tier. You can continue to choose from many drugs available, using yourpatient’s out-of-pocket cost as a consideration whenprescribing. We encourage you, when medicallyappropriate, to consider changing tier 3prescriptions to generic or preferred brand medicationsthat can help minimize your patient’s out-of-pocketexpenses. Oxford and our Members rely on yourjudgment; your support of this program can helpease any misconceptions your Oxford patients mayhave about generic and therapeutic substitution. It is our hope that by working together, we willpromote effective use of the three-tier benefit, while continuing to offer access to quality care.

Oxford reviews new drug products approved by the FDA or reviews current products when newinformation becomes available. The following is an update to the Preferred Drug List (PDL) forOxford’s three-tier prescription drug benefit. Thefollowing medications were reviewed by the P & TCommittee in October 2002 and December 2002.


Preferred Brand Non-Preferred PreferredTherapeutic Use (2nd Tier) Brand (3rd Tier) Alternatives

Acne therapy Solaraze Efudex

ADD/ADHD Focalin methylphenidate immediate release(generic), methylphenidate sustainedrelease (generic)

Antibiotics — Augmentin amoxicillin/potassium penicillinsPenicillins clavulanate (generic)

Antidepressants Paxil CR fluoxetine (generic), Paxil, Zoloft

Antihistamine Allegra Over-the-counter options now available

Antihistamine/ Allegra D Over-the-counter options now availableDecongestant

Antimalarial Lariam mefloquine (generic)

Antipsychotics Lithobid lithium carbonate (generic)

Diabetes Actos, Amaryl, Glucophage glipizide (generic), glyburide (generic), Glucophage XR, metformin (generic), Actos, Amaryl,Glucovance, Starlix Avandia, Glucophage XR, Glucotrol XL,

Glucovance, Prandin, Precose, Starlix

Gastric ulcer Cytotec misoprostol (generic)

Hormone Femhrt Femhrt, Premphase, PremproReplacement Therapy

Insulin Novolin Innolet, Humalog, Humulin, Iletin, Novolin, Novolog Novolin Innolet, Novolog

Multiple sclerosis Rebif Avonex, Betaseron, Copaxone, Rebif

Non-steroidal Bextra ibuprofen (generic), inflammatoryanti-agents nabumetone (generic), naproxen

(generic), oxaprozin (generic)

Prior Authorization ProgramsFor most Members with pharmacy benefit coverage through Oxford, the drugs on thefollowing list require prior authorization, alsoknown as precertification. Prior authorization is provided through Medco Health, based onOxford’s clinical criteria. To obtain precertification,please call Medco Health directly at 800-753-2851,Monday through Friday, 8 AM to 9 PM. Physiciansmay be asked to provide information explainingmedical necessity and past therapeutic failures.

A representative will collect all pertinent clinicaldata relevant to the service requested. For those requests that do not meet the criteria forapproval, physicians will be informed that coveragedetermination requires further review by an OxfordMedical Director. Physicians will receive notificationof all decisions upon receipt of all necessaryinformation required to render a decision.

The following is an updated list of commonly used outpatient prescription drugs that currentlyrequire prior authorization.

Anabolic steroids/androgens*• Androderm patches • Methyltestosterone• Anadrol – 50 • Oxandrin• Androgel • Testim• Android • Testoderm• Deca Durabolin • Testosterone• Depo-Testosterone • Winstrol• Halotestin

CNS stimulants• Adderall1 • Desoxyn1

• Concerta1 • Dextrostat1

• Dexedrine1

Acne medications• Avita2 • Retin A2

• Differin2

Proton pump inhibitors*• Aciphex • Prilosec• Nexium • Protonix• Prevacid

Misc. gastrointestinal medications*• Lotronex • Zelnorm

Impotence drugs**• Caverject • Muse• Edex • Viagra

Arthritis medications• Bextra* • Humira• Celebrex* • Kineret• Enbrel • Vioxx*

Specialized OB/GYN drugs• Lupron (3.75 mg & 11.25 mg)

Misc. medications• Nutritional Therapies3 • Serostim• Phoslo3 • Vitamin D Preparations

(i.e. Hectorol, Rocaltrol, etc.)

1 Applies only to Members age 19 and older.2 Applies only to Members age 40 and older.3 For coverage information, Members should contact Customer

Service at the number on their Oxford ID card.

Please note: Precertification requirements may vary, depending on the Member’s benefit.

This list is subject to change without notice. For the most up-to-date information, please callPharmacy Customer Service at 800-905-0201.

* Precertification is not required for OxfordMedicare Advantage Members.

** Medication is not covered for Oxford Medicare Advantage Members

2002 Clinical PracticeGuidelinesDetection, Diagnosis, and Treatment of AnxietyDisorders in Primary Care Setting 1

Overview Anxiety disorders are the most common psychiatricillnesses affecting both children and adults. Anestimated 19 million American adults suffer fromanxiety disorders and there is significant overlap or co-morbidity with mood and substance abusedisorders. These disorders can be characterized byrelatively early ages of onset, chronicity, relapsing or recurrent episodes of illness, and periods ofdisability. Although anxiety disorders are highlytreatable, only approximately one third of thosesuffering from anxiety disorders receive treatment.It is likely that the association between co-morbidanxiety and suicide is underestimated. Panicdisorder and agoraphobia, in particular, may be associated with increased risk of suicide.Practitioners should be sensitive to the occurrenceof anxiety disorders in their patient population,institute screening methods to identify anxietydisorders, and implement parameters for treatmentand referral.

1 Derived from: Mental Health: A Report of the Surgeon General Chapter 4-Anxiety, National Institute for Mental Health-Anxiety Disorders publication No. 00-3879,American Psychiatric Association (www.psy.org)Anxiety Disorders, under the review and supervision of the BehavioralHealth Committee of Oxford Health Plans. Updated and reviewed byRegional Quality Management, October 2002.



Types of anxiety disorders• Acute stress disorder

• Agoraphobia (with and without a history of panic disorder)

• Body dysmorphic disorder

• Generalized anxiety disorder (GAD)

• Obsessive-compulsive disorder (OCD)

• Panic disorder (with and without a history of agoraphobia)

• Post-traumatic stress disorder (PTSD)

• Social anxiety disorder (social phobia)

• Specific phobias

When to refer to a mental health specialistPrimary care physicians should refer a patient to a psychiatrist or experienced mental healthspecialist under the following circumstances:

• First and foremost, if the patient presents as a suicide risk

• All patients suffering from an anxiety disordershould be assessed for the risk of suicide by subtlequestioning about suicidal thinking, impulses,and personal history of suicide attempts

• Patients are generally reassured by questionsabout suicidal thoughts and by education thatsuicidal thinking is a common symptom of theanxiety, or depression itself

• The patient presents persistent reduced capacityto function

• The patient fails to respond to an adequate trial of anti-anxiety medication

• There is no evidence of social support

• The patient requires inpatient care

• The patient has a previous history of depressionor suspicion of bipolar disorder

• The patient is pregnant or plans to become pregnant

• The anxiety is resistant to treatment

• The patient has a complex medication regimen

• The patient has certain co-morbid conditions (i.e., substance abuse, major depression, bipolardisorder, dementia)

Diagnosing anxiety disorders1. Conduct a clinical interview to identify

symptoms of anxiety.

It may be useful to employ a self-reportquestionnaire,* which provides the patient with a written list of symptoms related to anxiety, and asks the patient to indicate anysymptoms experienced.

2. Be attentive to common patient complaints,including the following, which may indicate anxiety disorders when active medical work-ups are persistently negative:

Unexplained gastrointestinal (GI) symptoms,heart palpitations, rapid pounding heartbeat,tightness of chest, hyperventilation, weakness all over, tremors, dizziness, dry mouth, sweaty,confusion, speeded up thoughts, muscletension/aches, or fatigue

3. Seek other clinical clues in the patient history,including the following, which predispose for anxiety disorders:

• Prior episodes of anxiety or depression

• Family history of depression

• Family history of eating disorders, substanceabuse, or anxiety disorders

• Personal or family history of suicide attempt(s)

• Recent stressful life events

• Concurrent general medical illnesses

• Concurrent substance abuse

• Lack of social supports

• Use of Kava-Kava

4. Thoroughly evaluate the patient’s initial complaints with a medical review of systems and a physical examination.

* If you would like to obtain a copy of these guidelines or the self-reportquestionnaire, log in to your personalized account at www.oxfordhealth.com.Next, click on Policies and Guidelines under the Business Center Sectionand download the PDF.


5. Consider general medical conditions, including the following, in relation to anxiety disorders:

• Stroke

• Myocardial infarction (MI)

• Dementia

• Diabetes

• Side effects of medications

• Hyperthyroidism

• Parkinson’s disease

• Fibromyalgia

• Cancer

• Coronary artery disease medication

• Drug interactions

• Pseudodementia

• Alzheimer’s disease

6. Identify and treat potential known causes ofanxiety disorders, including the following (if present):

• Alcohol and drug abuse

• General medical disorder

• Causal non-mood psychiatric disorder

• Grief reaction

7. Screen for medications that can cause symptoms of anxiety or precipitate anxiety disorders.

Diagnostic criteria for anxiety disordersGeneralized anxiety disorder

1. The person experiences excessive anxiety andworry more days than not for at least six months,about a number of events or activities.

2. The person finds it difficult to control the worry.

3. The anxiety and worry are associated with threeor more of the following six symptoms, with atleast some symptoms present for more days than not for the past six months). Please Note: Only one item is required in children.

• Restlessness or feeling keyed up or on edge

• Being easily fatigued

• Difficulty concentrating or mind going blank

• Irritability

• Muscle tension

• Sleep disturbance (difficulty falling or stayingasleep, or restless, unsatisfying sleep)

4. The focus of the anxiety and worry is notconfined to features of an Axis I disorder. For example, the anxiety or worry is not abouthaving a panic attack (panic disorder), beingembarrassed in public (social phobia), beingcontaminated (obsessive compulsive disorder),being away from home or close relatives(separation anxiety disorder), gaining weight(anorexia nervosa), having multiple physicalcomplaints (somatization disorder), or having aserious illness (hypochondriasis). In addition, theanxiety and worry do not occur exclusively duringpost-traumatic stress disorder.

5. The anxiety, worry, or physical symptoms causeclinically significant distress or impairment insocial, occupational, or other important areas of functioning.

6. The disturbance is not due to the directphysiological effects of a substance (e.g., a drug of abuse or medication) or a generalmedical condition (e.g., hyperthyroidism), and does not occur exclusively during a mooddisorder, a psychotic disorder, or a pervasivedevelopmental disorder.

Obsessive-compulsive disorder1. The person has either obsessions or compulsions.

Obsessions• Recurrent and persistent thoughts, impulses,

or images that are experienced, at some timeduring the disturbance, as intrusive andinappropriate, and that cause marked anxiety or distress

• Thoughts, impulses, or images that are notsimple excessive worries about real-life problems


• The person attempts to ignore or suppress suchthoughts, impulses, or images, or to neutralizethem with some other thought or action

• The person recognizes that the obsessionalthoughts, impulses, or images are a product ofhis or her own mind (not imposed from withoutas in thought insertion)

Compulsions• Repetitive behaviors (e.g., hand washing,

ordering, checking) or mental acts (e.g.,praying, counting, repeating words silently) that the person feels driven to perform inresponse to an obsession, or according to rules that must be applied rigidly

• The behaviors or mental acts are aimed atpreventing or reducing distress or preventingsome dreaded event or situation; however, these behaviors or mental acts either are notconnected in a realistic way with what they are designed to neutralize or prevent or areclearly excessive

2. At some point during the course of the disorder,the person has recognized that the obsessions orcompulsions are excessive or unreasonable. Please Note: This does not apply to children.

3. The obsessions or compulsions cause markeddistress, are time consuming (take more than onehour a day), or significantly interfere with theperson’s normal routine, occupational oracademic functioning, or usual social activities or relationships.

4. If another Axis I disorder is present, the contentof the obsessions or compulsions is not restrictedto it (e.g., preoccupation with food in thepresence of an eating disorder; hair pulling in the presence of trichotillomania; concern withappearance in the presence of body dysmorphicdisorder; preoccupation with drugs in thepresence of a substance use disorder;preoccupation with having a serious illness in the presence of hypochondriasis; preoccupationwith sexual urges or fantasies in the presence of a paraphilia; or guilty ruminations in thepresence of major depressive disorder).

5. The disturbance is not due to the directphysiological effects of a substance (e.g., a drug of abuse or medication) or a generalmedical condition.

Panic disorder1. The person experiences recurrent unexpected

panic attacks. Criteria for panic attack:

• A discrete period of intense fear or discomfortin which four or more of the followingsymptoms develops abruptly and reaches a peak within ten minutes:

• Palpitations, pounding heart, or acceleratedheart rate

• Sweating

• Trembling or shaking

• Sensations of shortness of breath or smothering

• Feeling of choking

• Chest pain or discomfort

• Nausea or abdominal distress

• Feeling dizzy, unsteady, lightheaded, or faint

• Derealization (feelings of unreality) ordepersonalization (being detached from oneself)

• Fear of losing control or “going crazy”

• Fear of dying

• Paresthesias (numbness or tingling sensations)

• Chills or hot flashes

2. At least one of the attacks has been followed by one month or more of one or more of the following:

• Persistent concern about having additional attacks

• Worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, “going crazy”)

• A significant change in behavior related to the attacks

3. The panic attacks are not due to the directphysiological effects of a substance (e.g., a drug of abuse or medication condition, such as hyperthyroidism).


4. The panic attacks are not better accounted for byanother mental disorder, such as social phobia occurring on exposure to feared social situations,specific phobia on exposure to a specific phobicsituation, obsessive-compulsive disorder, inresponse to stimuli associated with a severestressor, or separation anxiety disorder, in responseto being away from home or close relatives.

Panic disorder with agoraphobia • Meets the criteria for panic disorder.

• Agoraphobia is present (see criteria below).

Panic disorder without agoraphobia• Meets the criteria for panic disorder.

• Agoraphobia is absent.

Agoraphobia without history of panic disorder1. The presence of agoraphobia related to fear of

developing panic-like symptoms (e.g., dizziness or diarrhea). Criteria for agoraphobia:

• Anxiety about being in places or situations from which escape might be difficult orembarrassing, or in which help may not beavailable in the event of having an unexpectedor situational predisposed panic attack or panic-like symptoms. Agoraphobic fears typicallyinvolve characteristic clusters of situations thatinclude being outside the home alone, being ina crowd or standing in a line, being on a bridge,or traveling in a bus, train, or automobile.Please Note: Consider the diagnosis of specific phobiaif the avoidance is limited to one or only a few specificsituations, or social phobia if the avoidance is limitedto social situations.

• The situations are avoided (i.e., travel isrestricted) or are endured with marked distressor with anxiety about having a panic attack or panic-like symptoms, or require the presenceof a companion.

• The anxiety or phobic avoidance is not betteraccounted for by another mental disorder, such as social phobia (i.e., avoidance limited to social situations because of fear ofembarrassment), specific phobia (i.e., avoidancelimited to a single situation like being in anelevator), obsessive-compulsive disorder

(i.e., avoidance of dirt in someone with anobsession about contamination), post-traumaticstress disorder (i.e., avoidance of stimuliassociated with a severe stressor), or separationanxiety disorder (i.e., avoidance of leaving homeor relatives).

2. Criteria have never been met for panic disorder.

3. The disturbance is not due to the directphysiological effects of a substance (e.g., a drug of abuse or medication) or a general medical condition.

4. If an associated general medical condition ispresent, the fear described in first criterion isclearly in excess of that usually associated with the condition.

Acute stress disorder1. The person has been exposed to a traumatic event

in which both of the following were present:

• The person experienced, witnessed, or wasconfronted with an event or events that involvedactual or threatened death or serious injury, ora threat to the physical integrity of self or others

• The person’s response involved intense fear, helplessness, or horror

2. Either while experiencing or after experiencing the distressing event, the individual experienced three or more of the following dissociative symptoms:

• A subjective sense of numbing, detachment, or absence of emotional responsiveness

• A reduction in awareness of his or hersurroundings (i.e., “being in a daze”)

• Derealization

• Depersonalization

• Dissociative amnesia (i.e., inability to recall an important aspect of the trauma)

3. The traumatic event is persistently re-experiencedin at least one of the following ways: recurrentimages, thoughts, dreams, illusions, flashbackepisodes, or a sense of reliving the experience; or distress on exposure to reminders of thetraumatic event.

4. Marked avoidance of stimuli (e.g., thoughts,feelings, conversations, activities, places, people)that arouse recollections of the trauma.

5. Marked symptoms of anxiety or increased arousal(i.e., difficulty sleeping, irritability, poorconcentration, hypervigilance, exaggerated startle response, motor restlessness).

6. The disturbance causes clinically significantdistress or impairment in social, occupational, orother important areas of functioning or impairsthe individual’s ability to pursue some necessarytask, such as obtaining necessary assistance ormobilizing personal resources by telling familymembers about the traumatic experience.

7. The disturbance lasts for a minimum of two daysand a maximum of four weeks and occurs withinfour weeks of the traumatic event.

8. The disturbance is not due to the directphysiological effects of a substance (e.g., a drug of abuse or a medication) or a generalmedical condition, is not better accounted for by brief psychotic disorder, and is not merely an exacerbation of a pre-existing Axis I or Axis II disorder.

Post-traumatic stress disorder1. The person has been exposed to a traumatic event

in which both of the following were present:

• The person experienced, witnessed, or wasconfronted with an event or events that involvedactual or threatened death or serious injury, ora threat to the physical integrity of self or others

• The person’s response involved intense fear,helplessness, or horror

2. The traumatic event is persistently re-experiencedin one or more of the following ways:

• Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptionsPlease Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.

• Recurrent distressing dreams of the eventPlease Note: In children, there may be frighteningdreams without recognizable content.

• Acting or feeling as if the traumatic event wererecurring (includes a sense of reliving theexperience, illusions, hallucinations, anddissociative flashback episodes, including thosethat occur on awakening or when intoxicated) Please Note: In young children, trauma-specificreenactment may occur.

• Intense psychological distress at exposure tointernal or external cues that symbolize orresemble an aspect of the traumatic event

• Physiological reactivity on exposure to internalor external cues that symbolize or resemble an aspect of the traumatic event

3. Persistent avoidance of stimuli associated with thetrauma and numbing of general responsiveness (not present before the trauma), as indicated bythree or more of the following:

• Efforts to avoid thoughts, feelings, orconversations associated with the trauma

• Efforts to avoid activities, places, or people that arouse recollections of the trauma

• Inability to recall an important aspect of the trauma

• Markedly diminished interest or participation in significant activities

• Feeling of detachment or estrangement from others

• Restricted range of affect (i.e., unable to haveloving feelings)

• Sense of a foreshortened future (i.e., does not expect to have a career, marriage, children,or a normal life span)

4. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two or more of the following:

• Difficulty falling or staying asleep

• Irritability or outbursts of anger

• Difficulty concentrating

• Hypervigilance

• Exaggerated startle response

5. Duration of the disturbance (symptoms in two,three, and four is more than one month.)



6. The disturbance causes clinically significantdistress or impairment in social, occupational, or other important areas of functioning.

Specify if:

• Acute: duration of symptoms is less than three months

• Chronic: duration of symptoms is three months or more

Specify if: • With delayed onset: onset of symptoms is at

least six months after the stressor

Social phobia1. A marked and persistent fear of one or more

social or performance situations in which theperson is exposed to unfamiliar people or topossible scrutiny by others. The individual fears that he or she will act in a way (or showanxiety symptoms) that will be humiliating or embarrassing. Please Note: In children, there must be evidence of thecapacity for age-appropriate social relationships withfamiliar people and the anxiety must occur in poorsettings, not just in interactions with adults.

2. Exposure to the feared social situation almostinvariably provokes anxiety, which may take theform of a situationally bound or situationallypredisposed panic attack. Please Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from socialsituations with unfamiliar people.

3. The person recognizes that the fear is excessive or unreasonable. Please Note: In children, this feature may be absent.

4. The feared social or performance situations are avoided or else are endured with intenseanxiety or distress.

5. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normalroutine, occupational or academic functioning, or social activities or relationships, or there ismarked distress about having the phobia.

6. In individuals under age 18, the duration is at least six months.

7. The fear or avoidance is not due to the directphysiological effects of a substance (e.g., a drug of abuse or a medication) or a generalmedical condition and is not better accounted for by another mental disorder (e.g., panicdisorder with or without agoraphobia, separationanxiety disorder, body dysmorphic disorder, a pervasive developmental disorder, or schizoidpersonality disorder).

8. If a general medical condition or another mentaldisorder is present, the fear described in Criterion1 is unrelated (i.e., the fear is not of stuttering,trembling, Parkinson’s disease, or of exhibitingabnormal eating behavior in anorexia nervosa orbulimia nervosa).

Specify if:• Generalized: the fears are of most social

situations (also consider the additional diagnosis of avoidant personality disorder)

Specific phobia1. Marked and persistent fear that is excessive or

unreasonable, and cued by the presence oranticipation of a specific object or situation (e.g., flying, heights, animals, receiving aninjection, seeing blood).

2. Exposure to the phobic stimulus almost invariablyprovokes an immediate anxiety response, whichmay take the form of a situationally bound orsituationally predisposed panic attack. Please Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging.

3. The person recognizes that the fear is excessive or unreasonable. Please Note: In children, this feature may be absent.

4. The phobic situation(s) is avoided or else isendured with intense anxiety or distress.

5. The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person’s normal routine, occupational or academic functioning, or social activities orrelationships, or there is marked distress abouthaving the phobia.

6. In individuals under age 18 years, the duration isat least six months.


7. The anxiety, panic attacks, or phobic avoidanceassociated with the specific object or situation arenot better accounted for by another mentaldisorder, such as obsessive-compulsive disorder(i.e., fear of dirt in someone with an obsessionabout contamination), post-traumatic stressdisorder (i.e., avoidance of social situationsbecause of fear of embarrassment), panicdisorder with agoraphobia, or agoraphobiawithout history of panic disorder.

Specify types

• Animal type

• Natural environment type (e.g., heights, storms, water)

• Blood-injection-injury type

• Situational type (e.g., airplanes, elevators,enclosed places)

• Other type (e.g., phobic avoidance of situationsthat may lead to choking, vomiting, orcontracting an illness; in children, avoidance of loud sounds or costumed characters)

Body dysmorphic disorder• Preoccupation with an imagined defect in

appearance. If a slight physical anomaly is present,the person’s concern is markedly excessive.

• The preoccupation causes clinically significantdistress or impairment in social, occupational, or other important areas of functioning.

• The preoccupation is not better accounted for byanother mental disorder (i.e., dissatisfaction with body shape and size in anorexia nervosa).

Differential diagnosis for anxiety disorders

• Trichotillomania

• Major depressive episode

• Hypochondriasis

• Delusional disorder

• Superstitions

• Repetitive checking behaviors

• Brief psychotic disorder

• Delirium

• Schizoid personality disorder

• Performance anxiety

• Tic disorder

• Anxiety disorder due to a general medical condition

• Substance-induced anxiety disorder

• Stereotypic movement disorder

• Eating disorders

• Paraphilias

• Pathological gambling

• Alcohol dependence or abuse

• Caffeine

• Adjustment disorder

• Pervasive developmental disorder

• Avoidant personality disorder

• Body dysmorphic disorder

• Psychotic disorder not otherwise specified

• Schizophrenia

• Over-the-counter drugs/herbal supplements

Treatment options for anxiety disordersAnxiety disorders are very treatable. Success will vary with the individual. Some respond to short-term treatment, while others may need to be treated longer. Treatment can be complicated bythe fact that people very often have more than oneanxiety disorder, or suffer from another co-morbidcondition such as depression or substance abuse.Therefore, treatment needs to be tailored to theindividual. Although individualized, there areseveral standard approaches that have proven to be quite effective. A therapist or psychiatrist mightuse one, or a combination of these therapies.

Behavioral therapyThe goal is to modify and gain control overunwanted behavior. The individual will learn to cope with difficult situations, often through


controlled exposure to them. This helps to give theindividual a sense of having control over their life.

Cognitive therapyThe goal is to change unproductive or harmfulthought patterns. The individual examines theirthoughts related to their feelings and behaviors andlearns to separate realistic from unrealistic thoughts.As with behavioral therapy, the individual is activelyinvolved in their recovery and has a sense of controlover their life.

Cognitive-behavioral therapy (CBT)This is a combination of cognitive and behavioraltherapies. The individual learns a combination of cognitive and behavioral skills that can be used as stated above to actively involve them in the treatment and provide a sense of control.

Relaxation techniques The goal it to help the individual develop the ability to more effectively cope with the stresses that contribute to anxiety, as well as with some ofthe physical symptoms of anxiety. The techniquesthat are taught include breathing re-training and exercise.

MedicationMedication is often used in conjunction with one or more of the therapies described above.Sometimes antidepressants or anxiolytics (antianxiety medication) are used to alleviate severe symptoms so that other forms of therapy can go forward. It is effective for many peoplesuffering from anxiety disorders, and can be either a short-term or long-term option, depending on the individual’s needs.

Managing medication for anxiety disordersPrior to initiating drug treatment• Primary care physicians are encouraged

to consult with, or refer to a psychiatrist concerning questions of appropriate treatment for anxiety disorders.

• It is essential to identify and refer any patients at risk for self-harm or medically meaningful self-neglect.

• Communicate the side effects of the medication.

• Communicate with the patient as follows:

• Frame the anxiety disorder as a medical illness,with specific signs and symptoms

• Refer to a neurochemical dysregulation in the brain

• Emphasize that having an anxiety disorder is not indicative of a personal weakness or fault

Steps in placing a patient on medicationStep 1: In selecting medication, consider:

• Prior positive response

• Response in family member

• Long-term side effects

• Age

• Concurrent general medical disorder

• Concurrent causal psychiatric disorder

• Interaction with concurrent non-psychiatricmedication

• Convenience

• Cost

• Patient preference

• History of substance abuse (considerantidepressant rather than benzodiazepine)

Step 2: Begin medication and be available by phone.

Step 3: Adjust dosage (every two weeks) andmonitor side effects (weekly/bi-weekly).*

Step 4: Reevaluate symptoms and side effects(weekly/bi-weekly).

Step 5: Assess symptomatic outcome at six weeks.For those with no meaningful symptomresponse by six weeks, referral to a specialist is recommended.

* Referral to a psychiatrist should be made if a previouslynon-suicidal patient begins to express suicidal thoughtsor behavior which have surfaced as a result ofundergoing treatment.


Medications for Use with Anxiety DisorderBrand Initial Dose for

Generic Name Name Tablets Initial Dose Titrate Dose Panic DisorderSelective serotonin reuptake inhibitors (SSRIs) — Prescribed for panic disorder, OCD, social anxietydisorder, generalized anxiety disorder. Most commonly prescribed:

Citalopram Celexa 20, 40 mg 20-40 mg/QD 20-60 mg/QD 10 mg

Fluoxetine Prozac 10, 20 mg 10-20 mg/QD 20-40 mg/QD 10 mg

Sertraline Zoloft 25, 50, 100 mg 50 mg/QD 100-250 mg/QD 25 mg

Paroxetine Paxil 10, 20, 30, 40 mg 10-20 mg/QD 20-60 mg/QD 10 mg

Fluvoxamine Luvox 25, 50, 100 mg 50-100 mg/QD 100-250 mg/QD 25 mg

Benzodiazepines — Used to treat generalized anxiety disorder, social anxiety disorder, panic disorder. Most commonly prescribed:

Lorazepam Ativan .5, 1, 2 mg 2 mg in 2-6 mg in divided doses divided doses

Flurazepam Dalmane 15, 30 mg 15 mg QHS 15-30 mg QHS

Clonazepam Klonopin .5, 2 mg .5 mg TID 8-10 mg in divided doses

Triazolam Halcion .125, .25 mg .125 mg QD .125-.25 mg QD

Chlordiazepoxide Librium 10, 25 mg 10 QD 20-40 mg QD

Temazepam Restoril 15, 30 mg 15 mg QHS 15-30 mg QHS

Oxazepam Serax 10, 15, 30 mg 10 mg TID/QID 10-15 (mild-mod.), 15-30 (severe) mg TID/QID

Diazepam Valium 2, 5, 10 mg 2 mg BID-QID 2-4 mg BID-QID

Azaspirones — Used to treat generalized anxiety disorder. Most commonly prescribed: Buspirone Buspar 10 mg 5 mg TID 30-45 mg in

divided doses

Tricyclic antidepressants (TCAs) — Used to treat panic disorder, PTSD, OCD (Anafranil only). Most commonly prescribed:

Clomiprimine Anafranil 10, 25, 50 mg 25 mg QD 100-200 mg QD

Amitriptyline Elavil 10, 25, 50, 75, 25 mg QHS 150-300 mg QHS100, 150 mg

Nortriptyline Pamelor 10, 25, 50, 75 mg 10-25 mg QHS 50-150 mg QHS

Desipramine Norpramin 10, 25, 50, 75, 100-200 mg QHS 200-300 mg QHS100, 150 mg

Imipramine Tofranil 10, 25, 50, 75, 5 mg QHS 150-300 mg QHS 100, 150 mg or in divided doses

Atypical antidepressants — Used to treat panic disorder, OCD, social anxiety disorder, generalized anxiety disorder. Most commonly prescribed:

Trazadone** Desyrel 50, 100, 150, 300 mg 50-100 mg QHS 200-600 mg/QD**Recommended for female patients only, due to risk of priapism in males. Nefazodone Serzone 100, 150 mg 100 mg BID 150-300 mg BID

Venlafaxine Effexor 25, 37.5, 50, 37.5 mg/QD 75-150 mg BID75, 100 mg


Monoamine oxidase inhibitors (MAOIs) have been used primarily in the treatment of certainatypical depressive sub-types or as a second line of treatment for depression, mostly in treatment-resistant patients. Due to the risk of lethalhypertensive crisis related to interactions withrelatively common foods containing tyramine, and with sympathomimetic drugs, their use in the primary care setting, in the absence of closepsychiatric consultation, is discouraged.

Consideration in treating anxiety disorders in the elderlyAnxiety is as prevalent in the elderly as it is in the young. However, how and when it appears is distinctly different. There is also as high anincidence of depression with anxiety in the elderlyas in the young. Being a woman and having a lessformal education both indicate risk factors foranxiety in older adults.

An anxiety disorder was most likely present at a younger age for those older adults who arecurrently experiencing one. Chronic physicalproblems, cognitive impairment, significantemotional losses, and other stresses unique to the aging process can bring about the anxiety.Anxiety disorders that present later in life aresometimes underestimated due to the following:

• Older patients are less likely to report psychiatricsymptoms and are more likely to emphasize their physical complaints.

• Some epidemiological studies have excludedgeneralized anxiety disorder, one of the mostprevalent anxiety disorders in older adults.

Recognizing anxiety in the elderlySeparating a medical condition from physicalsymptoms of an anxiety disorder is morecomplicated in an older adult due to increasedrealistic concern about physical problems, and ahigher use of prescription medications. Agitationtypical of dementia may also be difficult to separatefrom anxiety.

Treatment Treatment in most cases should start with theprimary care physician, as many older adults feel

more comfortable discussing these issues with adoctor they have an existing relationship with.Based on this trust, they may be more likely to go along with treatment or a referral to a mentalhealth professional. Antidepressants (especiallySSRIs), rather than antianxiety medication (e.g.,benzodiazepines) are the preferred medication for most anxiety disorders. Cognitive behavioraltherapy is being used increasingly to reduce anxiety in older adults.

A partnership between the older adult, the familyand the doctor is very important, so that the older adult has an advocate to ensure that issuesencountered during treatment, such as drug sideeffects, are dealt with in a timely fashion.

Considerations in treating anxiety disorders in children and adolescentsSome anxiety disorders are more common inchildhood than others. Some are specific to agedevelopment. Separation anxiety disorder andspecific phobia are more common in childrenapproximately ages six to nine. Generalized anxietydisorder and social anxiety disorder are morecommon during middle childhood and adolescence.Panic disorder can occur during adolescence as well. Depression has a high rate of co-morbidity in children, especially among teenagers.

Children display and react to symptoms of anxietydifferently, which can lead to difficulty in diagnosis. It can also be difficult to determine if the behavior is“just a phase” or really constitutes an anxiety disorder.

Social anxiety disorder • Usually diagnosed in mid-teens, it can be found in

children of preschool and grade school age. If nottreated, it can persist into adulthood. It may placethe child at risk for depression and alcohol abuselater in life. Childhood social anxiety disorder canbe displayed in a number of ways, such as schoolrefusal or avoidance.

• The child will usually refuse to go to school on aregular basis, or have problems staying in school.This is different than the child who is truant or avoids school because of antisocial behavior or delinquency.

• Social anxiety disorder can be displayed inchildren with separation anxiety. With separationanxiety disorder, a child will experience extremeanxiety when separated from parents orcaregivers, displaying an excessive desire to be incontact with them. It is not uncommon for thechild to fear for the parent or caregiver’s safety.Onset may occur before age of 18, but is mostcommon between the ages of seven through nine.

• Selective mutism is thought to be a severe form of social anxiety disorder. The child will refuse to speak in situation where speech is expected or necessary, interfering with school or socialactivities. Onset is usually before five years of age, and must persist for at least one month to be diagnosed.

Specific phobiaUnlike adults, children usually recognize their fearis irrational or out of proportion to the situation.While the child may not articulate their fears, theymay avoid situation or things they fear and endurethe anxious feelings.

Generalized anxiety disorder (GAD)Children with GAD tend to be very hard onthemselves, striving for perfection, sometimesredoing tasks repeatedly. They may also seekconstant approval or reassurance from others.

Panic disorderThe disorder can be diagnosed in a child whosuffers at least two unexpected attacks, followed by at least one month of concern over havinganother attack or losing control. The most common age of onset is in the early to mid-twenties.It is not common in young children, but can beginin adolescence.

Oxford ParticipatingHospitals

We have provided a list of all Oxford participatinghospitals in Connecticut, New Jersey, and New York;their provider ID numbers; and their Oxfordnetwork affiliation with our plans (e.g., FreedomPlan,® Liberty PlanSM (NY and NJ only), or OxfordMedicare AdvantageSM Plan). This list is current as of December 2002.

Most hospital services require precertification. Pleaserefer to Oxford’s Provider Reference Manual to verifywhich services require precertification. Participatingproviders can issue referrals for services at a hospitalthat does not require precertification, such asdiagnostic testing. When entering the Oxford ID of the hospital to which you are referring a Member,please be certain to use the letter “O” instead of thenumeral 0 (e.g., the Oxford ID for Bristol Hospital(HO4722) should be entered as the letter “H”, theletter “O”, and then the numerals 4722.)


Connecticut Hospitals

Provider ID Facility Name County Freedom Medicare

HO4982 Bradley Memorial Hospital HARTFORD X

HO3178 Bridgeport Hospital FAIRFIELD X

HO4722 Bristol Hospital HARTFORD X

HO9265 Charlotte Hungerford Hospital LITCHFIELD X

HO9999 Connecticut Children’s Medical Center HARTFORD X

HO3177 Danbury Hospital FAIRFIELD X

HO3414 Day Kimball Hospital WINDHAM X

HO4040 Greenwich Hospital FAIRFIELD X

HO3255 Griffin Hospital NEW HAVEN X X

HO1316 Hartford Hospital HARTFORD X

HO3446 Hospital of St. Raphael NEW HAVEN X X


Connecticut Hospitals (continued)

Provider ID Facility Name County Freedom Medicare

HO5555 Johnson Memorial Hospital TOLLAND X

HO4961 Lawrence & Memorial Hospital NEW LONDON X

HO4254 Manchester Memorial Hospital HARTFORD X

H378840 Middlesex Hospital MIDDLESEX X

HO9638 Midstate Hospital (effective 6/1/02) NEW HAVEN X

HO4381 Milford Hospital NEW HAVEN X X

HO2258 New Britain General Hospital HARTFORD X

HO4479 New Milford Hospital LITCHFIELD X

HO3170 Norwalk Hospital FAIRFIELD X

HO2601 Rockville General Hospital TOLLAND X

HO4380 Sharon Hospital LITCHFIELD X

HO9863 St. Francis Hospital and Medical Center HARTFORD X

HO1112 St. Mary’s Hospital NEW HAVEN X X

HO4512 St. Vincent’s Medical Center FAIRFIELD X

HO3172 Stamford Hospital FAIRFIELD X

HO4491 UCONN Health Center - HARTFORD XJohn Dempsey Hospital

HO1120 Waterbury Hospital NEW HAVEN X X

HO4529 William W. Backus Hospital NEW LONDON X

HO1661 Windham Community Hospital WINDHAM X

HO4716 Yale-New Haven Hospital NEW HAVEN X X

New Jersey Hospitals

Provider ID Facility Name County Freedom Liberty Medicare

HO4393 Atlantic City Medical Center ATLANTIC X X

HO3055 Barnert Hospital PASSAIC X X

HO3031 Bayonne Hospital HUDSON X X X

HO5880 Bayshore Community Hospital MONMOUTH X X

H507602 Burdette Tomlin Memorial Hospital CAPE MAY X X

HO1526 Capital Health System - Mercer Campus MERCER X X

HO1486 Capital Health System - Fuld Campus MERCER X X

HO3037 Centrastate Medical Center MONMOUTH X X

HO3057 Chilton Memorial Hospital MORRIS X X

HO3040 Christ Hospital HUDSON X X X


New Jersey Hospitals (continued)


HO3032 Clara Maass Medical Center ESSEX X X

HO3047 Columbus Hospital ESSEX X X

HO3063 Community Medical Center OCEAN X X

HO1448 Cooper Hospital - University Medical Center CAMDEN X X

HO1330 Deborah Heart and Lung Center BURLINGTON X X

HO3036 Englewood Hospital and Medical Center BERGEN X X

HO4874 General Hospital Center at Passaic PASSAIC X X

HO5252 Greenville Hospital HUDSON X X X

HO2010 Hackensack Medical Center BERGEN X X

HO3038 Hackettstown Community Hospital WARREN X X

HO2200 Holy Name Hospital BERGEN X X

HO1100 Hospital Center at Orange ESSEX X X

HO4402 Hunterdon Medical Center HUNTERDON X X

HO4276 Irvington General Hospital ESSEX X X

HO5253 Jersey City Medical Center HUDSON X X X

HO4052 Jersey Shore Medical Center MONMOUTH X X

HO4208 JFK Medical Center MIDDLESEX X X

HO3423 Kimball Medical Center OCEAN X X

HO3060 Meadowlands Hospital Medical Center HUDSON X X X

HO1016 Medical Center at Princeton MERCER X X

HO4527 The Medical Center of Ocean County OCEAN X X

HO5665 Memorial Hospital of Salem County SALEM X X

HO3044 Monmouth Medical Center MONMOUTH X X

HO3046 Morristown Memorial Hospital MORRIS X X

HO3175 Mountainside Hospital ESSEX X X

HO4417 Muhlenberg Regional Medical Center UNION X X

HO3048 Newark Beth Israel Medical Center ESSEX X X

HO3050 Newton Memorial Hospital SUSSEX X X

HO3033 Our Lady of Lourdes Medical Center CAMDEN X X

HO3062 Overlook Hospital UNION X X

HO3051 Palisades General Hospital HUDSON X X X

HO1002 Pascack Valley Hospital BERGEN X X

HO4488 Passaic Beth Israel Hospital PASSAIC X X

HO4953 Rahway Hospital UNION X X

New Jersey Hospitals (continued)Provider ID Facility Name County Freedom Liberty Medicare

HO4114 Rancocas Hospital BURLINGTON X X

HO1294 Raritan Bay Medical Center - Old Bridge MIDDLESEX X X

HO1294 Raritan Bay Medical Center - Perth Amboy MIDDLESEX X X

HO4649 Warren Hospital WARREN X X

HO3002 Riverview Medical Center MONMOUTH X X

H378168 Robert Wood Johnson Hospital at Hamilton MERCER X X

HO1111 Robert Wood Johnson Medical Center MIDDLESEX X X

HO5102 Shore Memorial Hospital ATLANTIC X X

HO4472 Somerset Medical Center SOMERSET X X

HO4115 South Jersey Hospital System - Bridgeton CUMBERLAND X X

HO4115 South Jersey Hospital System - Elmer SALEM X X

HO4115 South Jersey Hospital System - Millville CUMBERLAND X X

HO4395 South Jersey Hospital System - Newcomb CUMBERLAND X X

HO4498 Southern Ocean County Hospital OCEAN X X

HO3043 St. Barnabas Medical Center ESSEX X X

HO4729 St. Clare’s Hospital - Boonton MORRIS X X

HO4729 St. Clare’s Hospital - Denville MORRIS X X

HO4729 St. Clare’s Hospital - Dover MORRIS X X

HO4729 St. Clare’s Hospital - Sussex SUSSEX X X

HO3066 St. Joseph’s Wayne Hospital PASSAIC X X

HO4051 St. Francis Hospital HUDSON X X X

HO3064 St. Francis Medical Center MERCER X X

HO4206 St. James Hospital ESSEX X X

HO3056 St. Joseph’s Hospital and Medical Center PASSAIC X X

HO4053 St. Mary’s Hospital HUDSON X X X

HO1400 St. Mary’s Hospital - Orange ESSEX X X

HO1200 St. Michael’s Medical Center ESSEX X X

HO4263 St. Peter’s Medical Center MIDDLESEX X X

HO4758 Trinitas Hospital - Jersey Street Campus UNION X X

HO4220 Trinitas Hospital - Williamson Street Campus UNION X X

HO6262 Underwood Memorial Hospital GLOUCESTER X X

HO4319 Union Hospital UNION X X

HO3058 Valley Hospital BERGEN X X

HO4582 Virtua Memorial Hospital of BURLINGTON XBurlington County



New Jersey Hospitals (continued)


HO1015 Virtua West Jersey Hospital - Berlin CAMDEN X

HO1015 Virtua West Jersey Hospital - Camden CAMDEN X

HO1015 Virtua West Jersey Hospital - Marlton BURLINGTON X

HO1015 Virtua West Jersey Hospital - Voorhees CAMDEN X

HO3042 West Hudson Hospital HUDSON X X X

HO5100 William B. Kessler Memorial Hospital ATLANTIC X X

New York Hospitals


HO4282 Orange Regional Medical Center - Arden Hill Campus ORANGE X

HO4231 Bayley Seton Hospital RICHMOND X X X

HO4750 Beth Israel Hospital - North NEW YORK X X X

HO3080 Beth Israel Medical Center NEW YORK X X X

HO3093 Beth Israel Medical Center - KINGS X X XKings Highway Division

HO1012 Blythedale Children’s Hospital WESTCHESTER X X

H384535 Bon Secours Community Hospital ORANGE X X

HO3443 Bronx Lebanon Hospital Center BRONX X X X

HO3083 Brookdale Hospital Medical Center KINGS X X X

HO3146 Brookhaven Memorial Hospital SUFFOLK X X

HO3101 Brooklyn Hospital Center KINGS X X X

HO4828 Brunswick Hospital Center SUFFOLK X X

HO3084 Cabrini Medical Center NEW YORK X X

HO3085 Calvary Hospital BRONX X X X

HO4205 Catholic Medical Center of Brooklyn QUEENS X X X& Queens

HO4216 Catholic Medical Center of Brooklyn & QUEENS X X XQueens - Mary Immaculate Hospital

HO4207 Catholic Medical Center of Brooklyn & QUEENS X X XQueens - St. John’s Queens Hospital

HO4383 Catholic Medical Center of Brooklyn & QUEENS X X XQueens - St. Joseph’s Hospital

HO4413 Catholic Medical Center of Brooklyn & Queens - St. Mary’s Hospital of Brooklyn KINGS X X X

New York Hospitals (continued)Provider ID Facility Name County Freedom Liberty Medicare

HO3149 Central Suffolk Hospital SUFFOLK X

HO3071 Community Hospital at Dobbs Ferry WESTCHESTER X

HO4224 Coney Island Hospital BROOKLYN X X X

HO4436 Cornwall Hospital ORANGE X X

H377164 Eastern Long Island Hospital SUFFOLK X

H946659 Elmhurst Hospital Center QUEENS X X X

HO3088 Flushing Hospital and Medical Center QUEENS X X X

HO3166 Franklin Hospital Medical Center - NASSAU X X XMember of North Shore Long Island Jewish Health System

HO3129 Good Samaritan Hospital - Suffern ROCKLAND X X

HO3167 Good Samaritan Hospital - West Islip SUFFOLK X

HO4326 Orange Regional Medical Center - ORANGE XHorton Campus

HO3090 Hospital for Joint Diseases NEW YORK X X

HO3091 Hospital for Special Surgery NEW YORK X X

HO5080 Hudson Valley Hospital Center WESTCHESTER X Xat Peekskill/Cortlandt

HO3138 Huntington Hospital - Member of North SUFFOLK X XShore Long Island Jewish Health System

HO3159 Island Medical Center NASSAU X X

H406390 J. T. Mather Memorial Hospital SUFFOLK X

HO3092 Jamaica Hospital Medical Center QUEENS X X X

HO4317 Kingsbrook Jewish Medical Center KINGS X X

HO3069 Lawrence Hospital WESTCHESTER X X

HO3095 Lenox Hill Hospital NEW YORK X X X

HO3140 Long Beach Medical Center NASSAU X X

HO3097 Long Island College Hospital KINGS X X X

HO3102 Long Island Jewish Medical Center - NASSAU X X XMember of North Shore Long IslandJewish Health System

HO4049 Lutheran Medical Center KINGS X X X

HO4400 Maimonides Medical Center KINGS X X

HO3103 Manhattan Eye, Ear and Throat NEW YORK X X

HO3160 Mercy Medical Center NASSAU X X X

HO3114 Montefiore Medical Center BRONX X X X

HO3115 Montefiore Medical Center - Einstein Division BRONX X X X


New York Hospitals (continued)Provider ID Facility Name County Freedom Liberty Medicare

HO3077 Mount Sinai Hospital of Queens QUEENS X X X

HO4238 Mount Sinai Medical Center NEW YORK X X X

HO3075 Mount Vernon Hospital WESTCHESTER X X

H792190 Nassau University Medical Center NASSAU X X

HO3153 New Island Hospital NASSAU X X

HO3107 New York Eye and Ear Infirmary NEW YORK X X X

HO3081 New York Hospital Medical Center of Queens QUEENS X X X

HO4281 New York Methodist Hospital KINGS X X X

HO1248 New York Presbyterian Hospital - NEW YORK X X XAllen Pavilion

HO3119 New York Presbyterian Hospital - NEW YORK X X XCornell Campus

HO3111 New York Presbyterian Hospital - NEW YORK X X XPresbyterian Campus

HO4000 New York University Hospitals Center NEW YORK X X

HO4204 New York Westchester Square Medical Center BRONX X X X

HO1488 North General Hospital NEW YORK X X X

H367349 North Shore University Hospital - Forest Hills QUEENS X X X

HO4801 North Shore University Hospital - Glen Cove NASSAU X X X

HO3141 North Shore University Hospital - Manhasset NASSAU X X X

HO3147 North Shore University Hospital - Plainview NASSAU X X X

H378175 North Shore University Hospital - Syosset NASSAU X X X

HO1504 Northern Dutchess Hospital DUTCHESS X

HO3074 Northern Westchester Hospital Center WESTCHESTER X X

HO4869 Nyack Hospital ROCKLAND X

HO4218 NYU Downtown Hospital NEW YORK X X X

HO3109 Our Lady of Mercy Medical Center BRONX X X X

HO3183 Parkway Hospital QUEENS X X X

HO4644 Peninsula Hospital Center QUEENS X X

HO3125 Phelps Memorial Hospital Center WESTCHESTER X X

HO3070 Putnam Hospital Center PUTNAM X X

HO4200 Queens Hospital Center QUEENS X X X

HO4571 Saint Francis Hospital DUTCHESS X

HO3076 Sound Shore Medical Center WESTCHESTER X X

HO3145 South Nassau Community Hospital NASSAU X X



New York Hospitals (continued)


HO4447 Southampton Hospital SUFFOLK X

HO3068 Southside Hospital - Member of North SUFFOLK X X Shore Long Island Jewish Health System

HO1511 St. Agnes Hospital WESTCHESTER X X

HO4399 St. Anthony Community Hospital ORANGE X X

HO4366 St. Barnabas Hospital BRONX X X X

H2018325 St. Catherine of Siena Medical Center SUFFOLK X X

HO3168 St. Charles Hospital SUFFOLK X X

HO4608 St. Clare’s Hospital and Health Center NEW YORK X X

HO1069 St. Francis Hospital NASSAU X X

HO4391 St. John’s Episcopal Hospital - South Shore QUEENS X X X

HO3135 St. John’s Riverside Hospital WESTCHESTER X X

HO4501 St. Joseph’s Medical Center WESTCHESTER X X

HO4235 St. Luke’s - Roosevelt Hospital Center NEW YORK X X X

HO4201 St. Luke’s Hospital - Newburgh ORANGE X

HO3182 St. Vincent’s Medical Center of Richmond RICHMOND X X X

HO4217 St. Vincent’s Hospital and Medical Center NEW YORK X X X

HO4534 State University Hospital of Brooklyn KINGS X X

HO1666 Staten Island University Hospital: RICHMOND X X XConcord Site - Member of North Shore Long Island Jewish Health System

HO3123 Staten Island University Hospital: North - RICHMOND X X XMember of North Shore Long Island Jewish Health System

HO3123 Staten Island University Hospital: RICHMOND X X XSouth - Member of North Shore Long Island Jewish Health System

HO3086 The New York Community Hospital KINGS X X Xof Brooklyn

HO3127 United Hospital Medical Center WESTCHESTER X X

HO4212 University Hospital S.U.N.Y. at Stonybrook SUFFOLK X

HO5540 Vassar Brothers Hospital DUTCHESS X X

HO4245 Victory Memorial Hospital KINGS X X X

HO4302 Westchester Medical Center WESTCHESTER X X

HO3134 White Plains Hospital Medical Center WESTCHESTER X X

HO3142 Winthrop University Hospital NASSAU X X

HO3124 Wyckoff Heights Hospital KINGS X X X

Designed and printed by Onward Publishing, Inc. Northport, NY 11768

there is another way®

www.oxfordhealth.com

MS-02-1611 ©2003 Oxford Health Plans, Inc. 6038

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