Oscar Health Plan Insurance Coverage for Opioid Detox & Rehab Centers

If you have an Oscar health plan and are struggling with opioid addiction, you may be wondering if you can use your insurance to cover the costs associated with opioid rehab. Whether opioid rehab is fully or partially covered depends on your specific plan’s details. Additionally, your plan may have specific requirements for how you can use your insurance.

You may, for example, be limited to certain facilities or doctors as part of a network plan. To find out what your Oscar health plan coverage details include, like how many rehab centers may be in your plan’s network (if applicable), call the number on the back of your insurance card and speak to a plan representative.

What Does Oscar Health Plan Insurance Cover for Opioid Treatment?

Oscar health plan Insurance may provide a variety of coverage for various services, including those known as essential benefits, as almost all U.S. health plans are mandated by the Affordable Care Act to provide coverage for such services.¹ There are 10 EHBs, 1 of which is mental health and substance abuse services.¹ This means that your Oscar health plan may be required to provide some level of coverage for services such as inpatient mental health treatment, substance use disorder treatment, and behavioral health treatment.² For example, some of the following opioid treatments may be covered under your plan:

• Screenings, Often referred to as a 1st step of treatment, screenings and/or interventions are used by providers to assess your opioid use and determine whether you have an addiction.³ It is done prior to treatment, as providers need to assess your situation before recommending a treatment path.³
• Detox. In some cases, a provider may recommend medically supervised detox for you as you begin opioid treatment. Detox is the process in which you rid your body of drugs, alcohol, or both. It is often done in a medical setting to manage the potential acute and life-threatening effects of withdrawal.^{4, para 2}
• Inpatient. One type of rehab program is known as inpatient treatment and involves you staying at a facility for the duration of your treatment.^{5, (How are behavioral therapies used to treat drug addiction?)} Inpatient programs could last for days or weeks and even range for months, and due to the nature of the program, you can receive round-the-clock care and supervision.^{5, (How are behavioral therapies used to treat drug addiction?)}
• Outpatient. Another type of opioid treatment program is known as an outpatient program. The main difference between inpatient and outpatient treatment is that there is no overnight stay associated with outpatient care. ^{5, (How are behavioral therapies used to treat drug addiction?)} With outpatient programs, you typically receive treatment 1 or 2 times a week, or less frequently, and then return home after your session. ^{5, (How are behavioral therapies used to treat drug addiction?)}
• Behavioral therapies. Behavioral therapy is a certain type of treatment methodology that a provider may use at any point in your treatment program. It is designed to help you cope with the daily stressors you face without using opioids, modify your behaviors and attitudes, learn various life skills, and abstain from or stop opioid use.⁶
• Treatment for co-occurring disorders. A co-occurring disorder occurs when a person has both a mental illness and substance use disorder at the same time.⁷ Although it’s not believed that one directly causes the other, it is believed that you are twice as likely to develop one at some point in your life if you have the other.⁷ Due to the interconnected nature of the two, it’s recommended that you receive tandem treatment, where each condition is treated while you’re in rehab.^{7 “What should I do?”}

Please note that just because these treatment methods are listed above does not guarantee that they will be covered fully or partially under your Oscar health plan. What’s more, they may not be recommended for your personal opioid treatment plan. Work with your provider to determine what type of treatment is best for you, and call the number on the back of your Oscar health plan to learn more about what may be covered under your health plan.

What Oscar Health Plan Insurance does not cover for Opioid Treatment?

Depending on the Oscar health plan that you have, there may be certain types of opioid addiction treatment that are not covered under your plan. For example, some of the following treatment types may not be covered under your Oscar health plan:

• Non-medical amenities
• Holistic care services
• Recreation programs
• Food delivery
• Private treatment services
• Alternative therapies

Ask your mental health provider to learn more about what each of these therapies may entail, and ask your plan representative if they may be covered under your health plan.

What is Oscar Health Plan Insurance?

Oscar Health is a for-profit health insurance company in the United States that launched in 2012.^{8, “What we’ve accomplished”} As of 2022, Oscar Health provides plans in 3 different lines of business, the individual and family market, the Medicare Advantage market, and the small business market.^{8 “3 lines of business graphic” middle of page} Across the country, there are 22 states (a total of 607 counties) in which at least 1 type of plan offering is provided. ^{8, “What we’ve accomplished”} Collectively, over 1 million people are covered by an Oscar plan. ^{8 “We started Oscar to create a health insurance company that behaves like a doctor in the family.” section} To learn more about your specific health plan through Oscar or whether an Oscar plan is available near you, call 1-855-672-2788.

How Much Does Opioid Rehab Cost?

There is no straightforward answer when discussing the cost of opioid rehab or opioid addiction treatment. This is because there are a wide variety of factors that contribute to the final cost of care. One of the primary contributing factors is your Oscar health plan. Additionally, the extent of your plan’s coverage and where you seek care also affect the costs of your care.

Finally, depending on the plan you have, even though your plan may provide coverage for care, you may owe various out-of-pocket costs for using insurance. For example, you may have to pay for costs up to your plan’s deductible, and then insurance will kick in at a higher percentage. Call the number on the back of your plan’s card to learn more about your plan coverage. The rehab center you attend may also be able to provide you with a quote for services so you can get a rough estimate of what your opioid rehab treatment may cost you.

Cost of Inpatient Opioid Rehab

The costs of inpatient opioid rehab will vary widely depending on where you seek care, the services rendered, whether the center is in your plan’s network, and how long your stay may be, among other factors.

It’s important to keep in mind that, in general, due to the intensive care and nature of inpatient care (e.g., you’re living in the facility for the duration of your care), inpatient opioid treatment may cost more than outpatient care. However, every plan is different, so it’s recommended that you verify your benefits and coverage prior to seeking care when possible.

Cost of Outpatient Opioid Rehab

The average cost of outpatient opioid rehab will range from person to person. How your plan treats outpatient care may vary, and you may be limited to a certain number of covered visits per year or be limited to only seeing in-network providers. It’s important to go over your plan’s summary of benefits and coverage to better understand how it provides coverage for outpatient mental health services to get a better understanding of the costs you may incur when seeking outpatient opioid rehab.

Cost of Opioid Partial Hospitalization Programs (PHP)

A partial hospitalization program (PHP) is a type of structured outpatient program designed for various types of substance use disorders, including opioid addiction.⁹ PHPs generally are characterized by patients needing to attend a minimum number of hours of treatment each week, which is usually about 20 hours.⁹ The extent of your PHP, where you seek care, how long you need to be in treatment, and your Oscar health plan’s coverage details will all affect the overall cost of your treatment.

Cost of Medication-Assisted Treatment (MAT)

MAT is a type of addiction treatment in which your provider or care team will utilize prescription medication in your care plan to help manage your reduction in using opioids and could continue even after you’ve stopped using.¹⁰ It is designed to help manage potentially life-threatening side effects of withdrawal and is often used in the treatment of opioid addiction. Most health plans provide coverage for prescription drugs, but you’ll need to carefully review your plan’s details to learn more about how prescription drugs may be covered under your Oscar health plan.

Opioid Rehab vs. the Cost of Opioid Addiction

The cost of getting care may prevent some from prioritizing getting the care they need, but delaying treatment for opioid addiction has many negative consequences. Annually, according to the U.S. Centers for Disease Control and Prevention (CDC), the costs of untreated opioid addiction come to $78 billion.¹¹ Further, untreated opioid addiction is linked to higher rates of long-term health problems, which can be costly to manage and treat, incarceration, and poverty.¹¹

All of this goes to say that while it may seem expensive to treat opioid addiction, the risks of foregoing treatment can be even more costly. It’s important to prioritize getting the care you need today rather than pushing it down the road.

What Length of Opioid Rehab Does Oscar Health Plan Insurance Cover?

The length of time that you may be in treatment can affect your final costs of care. However, how long your plan may cover care varies. This is because there are many different types of policies and tiers of coverage, and coverage under an Oscar health plan is typically defined by those details. To learn more about your health plan’s coverage details when it comes to how long your plan provides coverage for opioid rehab, you can call the number on the back of your insurance card.

Despite how long your Oscar health plan may cover opioid rehab, it’s important to prioritize staying in treatment for as long as your mental health care provider recommends. Your insurance coverage and your provider’s recommendations for treatment length may not align. Remaining in treatment for long enough is essential to the success of your rehab program.

Every person is unique, and you may need to stay in treatment for longer or shorter than the average, but most experts recommend that treatment last at least 90 days to improve overall outcomes and reduce or stop opioid use.^{12, bullet 5} Work with your healthcare team to learn more about your specific recommendations for care.

Choosing between Oscar Health Plan Insurance Inpatient vs. Outpatient Opioid Rehab Centers

Depending on your personal situation, your provider may present you with the option of choosing between an inpatient vs. outpatient opioid rehab center. One type of treatment is not objectively better than the other, but rather, one may be better for your personal path to recovery.

Work with your healthcare provider to discuss the benefits and potential drawbacks to each type of setting, including the quality of care, treatment ecosystem, support groups, environment and focus level, and level of accountability required in each type of setting. From there, you can work with your team to choose the treatment center that makes the most sense for your situation.

How to Use Oscar Health Plan Insurance for Opioid Rehab?

You can use your Oscar health plan for opioid rehab many ways. Generally, the process begins by seeing a doctor who may screen you for your opioid use or addiction. Then, they may refer you to an opioid rehab center for treatment. From there, the rehab center or you can work with your Oscar health plan to sort out your insurance coverage and plan details. Most rehab centers will work directly with your insurance, and then you may receive bills for your personal costs associated with treatment. Every plan and rehab center is different, so be sure to sort out coverage details in advance whenever possible.

How to Find Opioid Rehabs That Accept Oscar Health Plan Insurance

If you’re ready to start the path to treatment, American Addiction Centers is here to help you demystify the insurance component of care. AAC can help you verify your insurance coverage for you and locate covered facilities near you. While you can certainly speak to your doctor about your treatment options and opioid rehab programs, AAC can also help you.

Call our helpline and speak to a person today who can check your benefits right while you’re on the phone. Our staff can also check whether your Oscar health plan is accepted at any of our industry-leading AAC locations nationwide that provide top-notch care. Together, we can help you get the care you need.