Does Oxford Health Insurance Cover Addiction Treatment?

Does Oxford Health Insurance Cover Addiction Treatment?

For individuals covered by Oxford Health Insurance, quality addiction treatment is both easily accessible and affordable. Oxford has extensive coverage for both addiction treatment and mental health treatment, though the specifics of coverage and the benefits offered depend upon the individual plan that a policyholder has. NuView Treatment Center works with Oxford Health Insurance and is considered in-network with most Oxford health plans. For individuals interested in long term recovery from the devastating effects of addiction, NuView Treatment Center has outpatient rehab programs geared toward all levels of addiction.

Oxford Health Insurance

Oxford Health was founded initially in 1984. It services the needs of policyholders in several US states, including New Jersey, New York, and Connecticut. Oxford Health Plans, as it is officially known, is technically a subsidiary of UnitedHealth Group. As a subsidiary of the largest healthcare company in the world, Oxford Health Plans has access to the world’s largest network of rehabs and healthcare providers. It is also widely known as being among the first healthcare companies to allow policyholders to visit specialists without needing a referral.

Oxford Health Plans offers a diverse array of distinct health plans for people with different needs and financial abilities. These include Medicare plans, large group, small group, individual plans, health maintenance organization (HMO), exclusive provider organization (EPO), preferred provider (PPO), and point-of-service (POS).

Addiction Treatment with Oxford Health Plans

All Oxford health plans cover addiction treatment. Moreover, Oxford does not distinguish between different types of addictions. No matter which substance an individual is struggling with, Oxford will cover the professional care that substance use disorder necessitates. Types of addictions covered by Oxford include:

  • Alcohol addiction
  • Prescription opioid addiction
  • Heroin addiction
  • Prescription stimulant addiction
  • Marijuana addiction
  • Crystal meth addiction
  • Benzodiazepine addiction

In most cases, addiction requires a variety of therapeutic modalities. Oxford recognizes that policyholders who suffer from substance use disorder frequently need to make use of multiple treatment programs in order to recover. For example, individuals who have finished an inpatient treatment program generally benefit considerably by enrolling afterwards in an outpatient rehab. Common elements of a treatment plan that Oxford provides coverage for include:

  • Medical detox centers
  • Residential or inpatient rehab
  • Outpatient rehab
  • Individual therapy, group therapy, and family therapy
  • Drug testing and drug screening
  • Psychiatric services
  • Medication-assisted treatment (MAT)

It is important to recognize, however, that the specific treatments that are covered depend upon the nature of the individual health plan a person is enrolled in. Additionally, not all Oxford health plans cover rehab stays for as long as others. Some plans limit the number of weeks or months that a person can stay in rehab. In other cases, plans set a maximum for how much they are willing to pay for rehab. Generally, however, rehabs that are within Oxford’s network of providers are better covered than out-of-network rehabs.

How Much Does Treatment Cost With Oxford Insurance?

While Oxford invariably covers addiction treatment services, the extent of this coverage differs significantly from plan to plan. In some cases, Oxford will cover the entire cost of a rehab or therapy session. Others plans, however, may only cover the cost partially. The out-of-pocket expenses are determined primarily by three factors: the policyholder’s state of residence, their specific health plan, and the severity of their addiction or mental health disorder.

Services covered by Oxford often necessitate obtaining a pre-authorization or referral. A referral means that Oxford requires policyholders to ask their primary care physician to make a diagnosis and approve a specific treatment regimen. A pre-authorization, however, comes directly from the insurance company. Oxford will arrange an assessment to evaluate the nature and severity of an individual’s substance use disorder. At that time, they will determine what kinds of services the patient needs, such as partial hospitalization, inpatient treatment, or intensive outpatient rehab.

Out-of-pocket expenses can include deductibles, copays, or coinsurance. Deductibles, which vary considerably from plan to plan, are pre-set amounts of money that policyholders are responsible for paying before their insurance kicks in. A copay refers to a small amount that a policyholder is responsible for paying each time they receive services. Coinsurance, on the other hand, refers to a percentage of the cost of treatment services that policyholders are responsible for.

All Oxford health plans have different copays, deductibles, and coinsurance costs. Plans with high monthly premiums tend to have more comprehensive coverage and lower out-of-pocket expenses. More economical plans with lower monthly premiums, on the other hand, may be associated with high out-of-pocket expenses and less comprehensive out-of-network benefits.

Will Oxford Tell My Employer?

While addiction often causes people to become temporarily or permanently unemployed, the reality is that the majority of people suffering from addiction are in the workforce. As such, it is a common concern for people seeking addiction treatment that their employer might find out. In most cases, employers are delighted that their employees are getting addiction treatment — since this is likely to make them better employees. However, this is not always the case, so it is understandable that many people want their addiction treatment to remain confidential.

Oxford, as well as the rehabs Oxford works with, cannot inform employers that their clients are seeking addiction treatment. In fact, rehabs and other treatment centers are bound by law to protect the health information of their clients. This information includes clients’ age, sex, race, mental and physical health conditions, the services they obtain, and their financial information.

Rehabs can only inform employers about their clientele when one or more of the following conditions have been met:

  • The client has committed a crime against the treatment center or their staff
  • A court order requires the rehab to reveal information
  • The client has provided written consent allowing the rehab to release personal information
  • The client is suspected of neglect of child abuse
  • An audit, program evaluation, or emergency has created mitigating circumstances

Outpatient Rehabs and Oxford Health Plans

Oxford healthcare plans have extensive coverage for outpatient rehabs. Outpatient treatment centers are widely considered as effective as inpatient rehabs. Unlike residential treatment programs, however, outpatient rehabs do not ask clients to live physically on the premises of their treatment center. Instead, clients attend treatment sessions once or several times a week. This makes outpatient programs flexible for clients who are employed or have family commitments. It also provides them with an opportunity to gradually build their lives in the outside world while obtaining support for their continued recovery. Meanwhile, for health providers like Oxford, the lack of a residency requirement makes outpatient programs far more affordable.

Oxford covers a wide range of distinct outpatient programs. Outpatient programs are suitable for individuals suffering from addiction at all levels of severity, because these rehabs include multiple levels of care. Many people with highly developed substance addictions begin in a more acute level of care and gradually move on to less acute treatment programs as they develop stronger foundations in sobriety. Studies show that progressing in treatment over extended periods of time results in a lower likelihood of relapsing. Oxford recognizes this and is therefore often willing to support policyholders during the entire length of their treatment program, when such a course of action is recommended by an outpatient rehab.

Levels of care covered by Oxford include:

  • Partial hospitalization programs (PHPs)
  • Intensive outpatient programs (IOPs)
  • Outpatient programs (OPs)
  • Aftercare planning

Medication-Assisted Treatment with Oxford Insurance

Medication-assisted treatment, sometimes known as MAT, is a treatment modality that combines medication with behavioral therapy. Medications prescribed during medication-assisted treatment help people stay physically sober. These medications include Suboxone, methadone, and buprenorphine. These drugs not only mitigate the intensity of withdrawal symptoms, but they reduce cravings. This reduces the likelihood of relapse and also helps patients take full advantage of the benefits of behavioral therapy.

Oxford Health covers medication-assisted therapy. While not all plans cover the entire cost of prescription drugs, some do. Ultimately, however, Oxford Health and other health insurance providers are legally required to offer the same coverage for medication-assisted treatment as they do for other prescription drugs. This policy, known as parity, means that the copays, deductibles, and coinsurance that policyholders are responsible for during MAT are no higher than the out-of-pocket fees associated with, for example, antibiotics.

Out-of-Network Providers with Oxford

In most cases, Oxford health plans suggest that policyholders use providers that are within their extensive network. Individuals can of course choose to see any provider they wish. However, when policyholders make use of out-of-network rehabs they are often responsible for more out-of-pocket expenses.

In-network rehabs and treatment providers have long standing relationships with health insurance companies. This allows them to provide services at specified, and generally more affordable, rates. These rehabs have also been evaluated by Oxford for quality, ensuring that they meet contemporary standards for care.

Oxford Health and the Affordable Care Act

The Affordable Care Act has helped more US citizens get access to health insurance than ever before. Moreover, it has also changed the way insurance companies operate when it comes to addiction and mental health. ACA, as the legislation is sometimes known, specifies that addiction treatment and mental health treatment are both classified as “essential health benefits.” As such, all health insurance providers are legally required to cover these treatments to some degree. Naturally, the comprehensiveness of one’s coverage, however, will always depend upon one’s specific treatment plan.

The Affordable Care Act also enforces parity when it comes to addiction and mental health treatment. This means that services relating to mental health or addiction cannot have different fee structures than services related to physical health conditions. If seeing a specialist for a physical ailment requires policyholders to pay a specific copay, that copay cannot be any higher for mental health or addiction specialists.

Health insurance companies can also not deny individuals coverage on the basis that they suffer from addictions or mental health conditions. The Affordable Care Act says that substance use disorders and mental illnesses are not pre-existing conditions. As such, Oxford and other health insurance providers are legally required to offer plans even to individuals with highly developed mental health or addiction problems — even when Oxford knows that they will likely require treatment.

What Does Oxford Cover For Me?

Determining one’s level of coverage can be difficult, since Oxford offers so many distinct health plans that differ from one another. In many cases, policyholders have questions even after talking with their Oxford insurance representative. Determining coverage levels can be made all the more difficult by addictions and mental health disorders, which can make completing everyday administrative tasks complicated or overwhelming.

If you or a loved one suffers from a substance use disorder and needs help, contact NuView Treatment Center today. Our staff members are available at all times for confidential consultations. We can help evaluate your treatment needs as well as get to the bottom of your plan’s specific coverage levels and benefits. Even if NuView Treatment Center is not appropriate for your needs, we will help connect you with services that apply to your specific circumstances. Contact us at (310) 984-1730, and you can begin to get the help you need.

Outpatient Care at NuView Treatment Center

NuView Treatment Center is an outpatient program centrally located on the westside of Los Angeles. Our modern facility is known for offering the latest evidence-based treatment modalities to help clients recover from the devastating effects of addiction and mental health conditions. At NuView Treatment Center, we believe that evidence-based therapies and compassion can help people suffering from addiction at all severities.

We believe that addiction recovery is not one-size-fits-all. Instead, our highly trained staff devise individualized treatment plans for every client. We recognize that all clients have distinct underlying issues that need to be addressed during the recovery process. These range from mental health disorders to conflictual family dynamics. In our outpatient programs, clients work daily to learn new coping skills and strategies to face their unique triggers. Meanwhile, they take steps toward building new and fulfilling lives for themselves in sobriety.

Our outpatient programs include every level of care, including partial hospitalization programs, intensive outpatient programs, outpatient programs, and aftercare planning. We offer medication-assisted treatment and dual diagnosis treatment as well. No matter what your background, anyone can achieve recovery at NuView Treatment Center. We are also covered by Oxford health plans, ensuring that treatment is not only effective but affordable as well.

If you are ready for freedom from substance addiction, contact NuView Treatment Center today.

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