Oscar Health signs up Florida Hospital, HCA
Systems will offer in-network services
Oscar Health, a young insurance company that is entering the Florida market for the first time this year, has struck agreements with Florida Hospital and HCA, offering plans in Lake, Orange, Osceola and Seminole counties.
That means the two health systems will be in-network for Central Floridians who choose one of Oscar’s plans this year during the Obamacare open enrollment period, which begins Nov. 1.
The company did not say what other providers are included in its Central Florida network but said it intends to have individual practices in its plans.
“While the specifics of our plans are not yet available, Orlando residents can expect a choice of plans with varying deductibles,” a company spokeswoman said.
Based in New York, Oscar was founded in 2012 by Mario Schlosser and Josh Kushner, the brother of senior White House adviser Jared Kushner.
The company began offering individual plans in New York in 2014, and since then it has focused on creating narrow networks by partnering with at least one major local health system.
“What we’re looking for are providers who have a robust bed [number], but most importantly, align with our vision, which is better outcomes and saving costs,” said Will Johnson, Oscar’s Florida market director.
Daryl Tol, Florida Hospital’s president and CEO, said in a statement that the health system’s agreement with Oscar “is another way to give consumers a choice that taps into a broad network of physicians and services and delivers world-class care at an affordable price.”
Experts say what differentiates Oscar from legacy insurance companies is the way it uses data and technology to drive the consumer experience. But it is too soon to tell whether such models will actually lead to better outcomes and cost savings, said Lindy Hinman, a senior vice president at Avalere Health, a national health-care consulting firm.
Oscar is one of several start-ups in the health-care arena aiming to appeal to the younger, tech-savvy generation and break away from the old models of care — whether it’s how we buy eyeglasses or order medications.
The company’s app and website make it easy for members to reach a doctor via telemedicine for free or text customer service — called the concierge team — to set up doctor appointments and find answers to billing questions. The team, which includes nurses, also checks on members after they are discharged from the hospital or emergency room.
“We’re doing all of this on Oscar’s own technology,” Johnson said. “All the core insurance functions are owned by us. We have our own in-house claims processing, so we can look at the quality of care.”
Whereas most insurance companies rely on static and sometimes outdated provider
directories to decide their networks, Oscar says it uses the constant stream of claims data to update its directory, company officials said.
The company does not require referrals for specialists.
All this could help bring consumers and providers closer together and make the insurance company less of a factor in the health-care equation, said Hinman of Avalere.
“There's an untested theory out there that some of these companies that have a tech platform on top of data could bring something new to the consumer, like more of a personalized experience and potentially more personalized decisions about their health care. But that’s to be determined,” she said.
Despite the company’s emphasis on technology and data, its members can find themselves in predicaments that are common with established insurance plans.
Most recently, a California man who had signed onto Oscar in the state exchange Covered California found out many of his bills would be denied or only partially covered by Oscar because the trauma center where he was taken was out of the insurance company’s network, according to CNBC.
“We can’t speak to the specifics of this case due to HIPAA regulations that prohibit insurers from sharing private member information. Our goal at Oscar is to work closely with our members, to support them, and to provide them with the right resources so that we can resolve issues like this expediently,” a company spokeswoman said in an email.
Oscar expanded its reach this year from six to nine states, including Florida, Arizona and Michigan, and increased its individual membership by more than double to 252,000. Most recently, it received a $375 million investment from Google’s parent company, Alphabet, and it has plans to enter the Medicare Advantage market by 2020.
Oscar is one of seven insurers to offer individual plans on and off the marketplace in Central Florida during Obamacare open enrollment, starting Nov. 1.