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.