Oxford HealthCare Insurance Coverage
Finding a way to pay for your behavioral health needs, including addiction treatment, can be challenging. After all, substance use treatment programs can be quite expensive and, if you don’t have the funds in place, it can be difficult to get the help you need.
Thankfully, through insurance companies and healthcare financial assistance providers like Oxford HealthCare, you can begin your journey to recovery through treatment without having to worry about the financial aspect of treatment.
When it comes to the subject of recovery, there is plenty to think about and consider. There’s the question of where you should go to get treatment and whether you should enroll in an inpatient or outpatient program. There is the question of how long treatment will take. And, for many people, there’s at least a slight concern about whether or not they will be able to truly overcome addiction.
With all of these questions and concerns, thoughts about finances would only add more pressure to individuals who are seeking treatment. But, here at Discovery Institute, we are dedicated to helping our clients get the help they need, calm their fears, and find true freedom from addiction, worry-free.
This is why we work to help people understand their insurance plans and the details of coverage for treatment. So, if you have a plan with Oxford HealthCare, we’ve got some information that may prove to be helpful to you as you seek treatment for substance dependence.
Does Your Oxford Health Plan Cover Addiction Treatment?
Oxford HealthCare is a division of United Healthcare, a company that offers nationwide coverage. Established in 1984, Oxford Health has been providing healthcare coverage for individuals in the states of New Jersey, New York, and Connecticut for years.
Oxford offers various types of plans, including individual and group plans, as well as Medicare plans. This company offers behavioral health benefits, including benefits for behavioral health needs which involve mental health care and substance use disorder treatment.
Although insurance coverage details will vary depending on the type of plan you have, many plans through this company offer coverage for addiction detox services, therapy, dual diagnosis treatment, and medications that are used in treatment.
There are various types of addiction, including dependence problems that involve legal or illicit substances. Some legal substances which people may become dependent on or addicted to include alcohol and prescription medications (benzodiazepines, opioids, etc.). Illicit drugs that are commonly seen in cases of addiction are cocaine, heroin, and methamphetamine.
The good news is that people who have an Oxford insurance plan can receive coverage for the treatment of these different types of addiction. Here at Discovery Institute, we will work to help you sort through your insurance plan to get information about how your plan will cover treatment for addiction in your life.
Does My Treatment Need Come From an In-Network Facility?
In-network treatment centers, also known as Network Providers, are facilities that have an indirect or direct agreement with your insurance provider. In this case, network providers have a relationship with Oxford. Out-of-network facilities, referred to as non-network providers, do not have a direct or indirect agreement or relationship with Oxford.
It’s important to know whether or not your insurance plan will cover services from a non-network provider before you decide where you will receive treatment.
Again, coverage details will vary depending on the type of insurance plan you have with Oxford Health. This company offers 3 different types of plans, each having a different set of specifics and benefits. These plans are:
Bronze Copay 50: The Bronze plan has a 50% coinsurance for inpatient and outpatient network providers after your deductible has been met. (This means that you will need to pay 50% out-of-pocket plus any deductible that may apply.) It does not offer coverage for non-network outpatient care providers. If, however, you receive care from a non-network inpatient care provider, you have to get a preapproval from the insurance company. Otherwise, any benefits you receive will be decreased by half.
Silver Copay 70: This plan has a 30% coinsurance, for inpatient network providers after your deductible has been met, which means that you will need to pay 30% of the medical expenses (plus any deductible you may owe) and the insurance company will cover the remaining 70% of the healthcare cost. As far as outpatient network providers are concerned, there is a $50 copay and deductibles don’t apply. It does not offer coverage for non-network outpatient care providers. If, however, you receive care from a non-network inpatient care provider, you have to get a preapproval from the insurance company. Otherwise, any benefits you receive will be decreased by half.
Silver Copay 80: This Silver plan has a 20% coinsurance for inpatient network providers after your deductible has been met, meaning that you will need to pay 20% of your healthcare expenses (plus any deductible you may owe). The insurance company will cover the remaining 80%. For the services of outpatient network providers, there is a $50 copay and deductibles don’t apply. This plan does not offer coverage for non-network outpatient care providers. If, however, you receive care from a non-network inpatient care provider, you have to get a preapproval from the insurance company. Otherwise, any benefits you receive will be decreased by half.
Note: Oxford understands that there are situations in which you may need to seek immediate and emergency medical attention for symptoms related to substance use disorders. Sometimes, these situations are life-threatening and urgent, which may not allow you the time to seek an in-network provider. Should you end up using the services of an out-of-network provider in the case of an emergency, your plan will likely provide coverage.
Oxford Coverage for Addiction Detox
In many cases of addiction, individuals who are dependent on or addicted to substances such as alcohol or drugs require medical assistance as they work to end substance dependence in their lives. Often, ending alcohol or drug use without this kind of help proves to be harmful and, in some cases, life-threatening.
Substances such as benzodiazepines are especially difficult to withdraw from as symptoms of withdrawal can be extremely intense and severe. Individuals who attempt to end benzo misuse without clinical supervision could be at risk for serious consequences. So, in most cases of substance withdrawal, it’s important for people to have medical guidance and care throughout the process.
Oxford Health Plans tend to cover detoxification for alcohol and drug use. So, depending on the type of plan you have, your insurance plan may offer coverage for drug or alcohol medical detox programs. But, it’s important to check with your insurance provider to find out whether or not your detox process is covered. If the detox is considered medically necessary, it’s likely that you will have coverage.
Oxford Coverage for Inpatient and Outpatient Treatment
Treatment for addiction may come in the forms of inpatient, partial hospitalization, intensive outpatient, and outpatient. Although partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs) are both commonly seen in the recovery world, inpatient (residential) and outpatient programs are two of the most common types of treatment.
In an inpatient addiction treatment program, individuals live at their rehab facility for the duration of their program. During this time, they attend therapy and counseling sessions, develop relapse prevention skills, and build support systems of professionals along with others in recovery.
Outpatient programs do not require individuals to live at the treatment facility. Instead, people in these programs can live at home or in a sober living facility. Still, they attend therapy sessions and get treatment throughout the duration of their outpatient program.
Often, people attend outpatient treatment after they complete an inpatient program. But, whether you need to enroll in a residential or outpatient program, your plan may cover treatment, especially if you go to a network facility.
Treating Mental Health With Oxford Coverage
Many times, people who suffer from substance use disorder also struggle with mental health disorders. This occurrence is referred to as a dual diagnosis. The presence of two or more disorders (addiction and 1 or more mental health disorders) is referred to as “co-occurring disorders”.
When a person has co-occurring disorders, he or she should receive care from a dual diagnosis program. Treatment programs that focus on both mental health and substance use disorders can help individuals to cope with the symptoms of their behavioral health challenges and equip them with the skills they need in order to end substance dependence in their lives.
Sometimes, people become dependent on alcohol, prescription drugs, or illicit drugs as a result of the symptoms of their mental health disorders. In other cases, substance misuse causes certain mental health disorders to develop. Since addiction and behavioral health problems are so closely related, dual diagnosis programs are absolutely necessary when it comes to treatment.
Some of the behavioral and mental health disorders that may occur along with addiction are:
- Eating Disorders
- Bipolar Disorder
- Obsessive-Compulsive Disorder (OCD)
- Post-Traumatic Stress Disorder (PTSD)
- Attention-Deficit Hyperactivity Disorder (ADHD)
Oxford offers behavioral health benefits that can be used to help cover treatment for mental health disorders.
Let the Team at Discovery Institute Help You!
Here at Discovery Institute, we understand that navigating through the details of your insurance plan can be challenging for you. It can be overwhelming and, sometimes, confusing. But, our team is here to help you so that you can simply focus on overcoming substance dependence in your life!
For more information about our services and how we can help, please contact us today.