Oscar Health Insurance Review & Complaints: Health Insurance (2023)

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Oscar Health Insurance is entering the post-Affordable Care Act market with a new approach and a modern attitude. This unusual insurer aims to keep healthcare as simple as possible while still offering comprehensive coverage with a technological edge not seen elsewhere to customers, hoping to set them up with the care they need in order to live a healthier life.

What is Oscar Health Insurance?

Oscar Insurance was launched in July of 2013 in response to the Affordable Care Act with the intention of creating a user-friendly approach to health care. The company is known for a somewhat lighthearted and technologically advanced approach to health insurance. So far, the company has outstripped expectations for policy sales, entering the 2014 open enrollment period with 17,000 members, more than the 7500 anticipated by that time.

Oscar Health is known for using technology and unique methods of approaching healthcare rates and policies. In December of 2014, the company announced that they would provide insured members with a fitness monitoring device and offering cash incentives to those who use them. The company is also well known for being one of the tech-based health insurers, using a cloud system of billing and documentation and providing many online and mobile services.

Oscar currently offers their Simple Plans in New York, California, and Texas. The company previously offered plans in New Jersey and has plans to return next year, in addition to adding Ohio and Tennessee to the list.

What types of insurance products are offered?

Oscar Insurance offers what they call Simple Plans. These health insurance products are designed to be simplified and easy to use and understand. They offer a variety of premiums and deductibles. Several plans offer free doctor visits and free generic prescriptions, while others have low co-pays or co-insurance, depending on the plan chosen.

Following the ACA standards, Oscar’s plans come in Secure, Bronze, Silver, Gold, and Platinum coverage choices. Each level has several options. The company’s website shows a comparison chart between the plans. The difference is mainly between the premiums and the deductibles. The lower the premium, the higher the deductible, while the medical care remains the same.

Oscar healthcare plans include a free service known as Doctor On Call, which allows members to call and speak to a doctor over the phone. These doctors can answer questions, listen to symptoms, and provide prescriptions to be sent directly to a local pharmacy, all over the phone. The service is designed to prevent members from having to visit a doctor for common illnesses and quickly obtain the needed medications.

All of the plans meet the ACA requirements for deductibles and out-of-pocket maximums as well as required coverage. Currently, Oscar plans are not available through the online national health insurance marketplace for health care plans, but only through the Oscar website directly.

What about the health care providers and networks?

Health care providers submit medical claims directly to Oscar for benefits processing, as with most insurance companies. The Oscar website includes a comprehensive provider portal that allows doctors and clinics to handle all of their business with the company online – a part of Oscar’s paperless, “cloud” approach to handling documentation.

In an attempt to work with the best hospitals and doctors and ensure the best care, Oscar has reduced its network providers in New York and is now working with three hospital systems. This is in effect as of 2017. Their previous network included around 77 hospitals and this new network includes around 31. While this is a drastic change, with a lot of criticism, Oscar presses this is the best for their customers and stresses the action was not an attempt to increase their bottom line, though it does increase prices.

Prospective members can search to confirm whether or not their current doctors will accept Oscar Health insurance prior to signing up for a plan. Oscar Health services do not require a referral to see a specialist except in the case of specific provider types, such as alternative care providers.

Are the company’s health insurance rates affordable?

As with most insurance companies, prices and premiums for health insurance plans vary greatly based on the number of people insured, location, and several other factors. Oscar Insurance premiums can be obtained by requesting a quote online or by calling for a quote.

Expect Bronze level and Secure coverage health plans to generally offer the lowest prices, with Platinum level health plans at the highest premiums. This is due to the many differences in health plans with tiers separated by coverage levels, deductible amounts, co-pays, and coinsurance costs, and is common to most insurance companies.

Oscar Health Insurance is known for adding value to its health insurance policy in the form of cash incentives for behaviors that help to keep members healthy, which is good for the health insurance company’s bottom line. In addition to the incentive for using a fitness tracker and increasing activity, Oscar Health has previously offered members a cash incentive to get a flu shot. These offers can help to reduce the overall cost of Oscar plans.

Is the claims process simple?

Healthcare providers submit claims directly to Oscar for processing, as with most insurance companies. The Oscar website includes a comprehensive provider portal that allows doctors and clinics to handle all of their business with the company online – a part of Oscar’s paperless, “cloud” approach to handling documentation.

Oscar members can log in to the company website to review their benefits and claims status, and concerns regarding how benefits are paid can be directed to the company’s customer service line.

Are there consumer complaints against the company?

Oscar Insurance is very new to the healthcare industry, and although they are not accredited by the Better Business Bureau (BBB) , they are rated on complaints. The company has an F rating from the BBB due to 14 complaints filed against them about a negative experience, three of which they have failed to respond to, a poor complaint ratio.

Oscar Insurance does appear to have had some initial problems with confusion in the wording of their policies and members; one particular complaint received press attention. Oscar seems to be working to improve the miscommunication that led to the issues.

As with most new companies, Oscar Insurance will require more time in the health insurance industry to develop a solid reputation, and for a clear picture to emerge regarding complaints and customer service issues.

What is the company’s financial strength rating?

What is the bottom line?

Oscar is a very new company with a modern approach to health insurance plans that may appeal to those who have been frustrated with traditional insurance companies in the past or find the individual plans elsewhere too complicated. The company has had some issues with customers that do not seem to be greatly affecting their presence in the market and seems to be improving with time. Healthcare customers who prefer a technologically advanced insurance company and affordable health insurance rates are likely to find Oscar a good choice, as well as people with relatively simple health insurance plan needs.