Does Oxford Health Cover Drug and Alcohol Rehab? - Treatment Solutions

Does Oxford Health Cover Drug and Alcohol Rehab?

Using Oxford Health Insurance for Alcohol and Drug Treatment

Oxford Health Plans is an American healthcare company that provides health insurance benefit plans to members who reside in New York, New Jersey, and Connecticut.1 Oxford Health members have access to over 83,000 physicians and other healthcare professionals to work with at over 125,000 offices and more than 220 hospitals in-network.2

In 2004, Oxford Health became a subsidiary of UnitedHealth Group—the largest healthcare company in the world.3 Oxford Health provides coverage for individuals, families, and employers. The provider offers Point of Service (POS) plans, which include the Freedom Plan and Liberty Plan.1 Health Maintenance Organization (HMO) and third-party administered group insurance plans are also available through Oxford Health.1

Oxford Health’s size and reach allow it to offer a wide range of health insurance plans to meet the needs of most individuals, families, and groups.

If Oxford Health is your healthcare insurance provider, your policy likely covers some of the costs of drug and alcohol treatment. Call the number on the back of your insurance card for more information about what your specific plan covers for drug and alcohol rehab. Alternatively, you can call us at (888) 968-0834 to speak to an admissions navigator who can check your coverage while you’re on the phone.

What Will Oxford Health Cover?

Oxford Health offers coverage for addiction treatment for members who need help recovering from substance use disorders.3, [p 70] Oxford’s Behavioral Health (BEH) Department specializes in managing mental health and substance use treatments for its members. The office handles pre-authorization forms, referrals, and case management for Oxford members.[3, p 70]

Addiction treatment services that Oxford Health policies may cover include:[3, pp 70, 71, 72]

  • Medically assisted detox.
  • Inpatient treatment.
  • Outpatient therapy and medication management.
  • Medication-assisted treatment (MAT).
  • Dual-diagnosis treatment programs.
  • Outpatient detox.
  • Partial hospitalization programs (PHP).
  • Outpatient treatment.

The following is detailed information about the types of addiction treatment services covered by Oxford Health4:

  • Medical detox: Medications are used during the withdrawal process to help you or your loved one safely withdraw from drugs and/or alcohol. Medical supervision is provided by certified and trained staff members around the clock while you undergo medical detox. This is known as medication-assisted detox treatment or medical detox.
  • Partial hospitalization (PHP): Partial hospitalization programs—sometimes referred to as “day treatment”—allow you to live at home while attending treatment during the day. This is a commitment similar to a full-time day job and most PHP programs last between 15-90 days.
  • Intensive outpatient (IOP): Intensive outpatient programs require you to attend treatment programs/meetings a few times a week. You may live at home and work during the day and must attend treatment in the evenings. IOPs are an excellent choice for those who have work and family obligations they need to attend to during the day.
  • Inpatient treatment/residential rehab: Inpatient treatment/residential rehab requires you to live in a rehab facility 24 hours a day, 7 days a week for a prescribed duration of time, most often from 30 to 90 days. While in inpatient treatment, you attend 1:1 counseling as well as group therapy to help overcome addiction and learn healthy coping mechanisms to get and stay sober.
  • Outpatient treatment: Outpatient programs are recommended for individuals who need significant support in their journey to sobriety but cannot or do not want to enter inpatient rehab. Depending on the program, a person may be required to attend treatment for a certain number of hours a day, typically for 2 to 7 days a week.

Knowing that your treatment is covered by your Oxford Health plan can provide much-needed peace of mind without worrying about the financial impact of seeking help to get and stay sober. Oxford’s Behavioral Health Department has a toll-free line dedicated to members. You can call 1-800-201-6991 to obtain referrals for substance use treatment and discuss what is covered by your plan.4

Does Oxford Health Cover Mental Health Care?

Oxford Health provides a wide range of behavioral health and substance abuse support and services for its members.2

In many cases, substance use disorder and other mental health conditions such as anxiety, depression, mood disorders, and PTSD go hand-in-hand. More than 8 million adults aged 18 and older have mental illness and substance use disorder at the same time.[5] This is known as a co-occurring disorder or dual diagnosis.

It is important to treat both mental health disorders and substance use disorders at the same time for optimal treatment outcomes.6 Selecting a rehab treatment facility that treats both types of conditions is best for those with one or more mental health conditions as well as addiction.

Oxford Health has contracts for both inpatient and outpatient services for the treatment of mental health and substance abuse conditions. These services require pre-certification from either your primary care physician or an in-network outpatient specialist.4

How Long Does Oxford Health Cover Drug Rehab?

Oxford Health provides a wide variety of policies and plans for its members. Each policy’s coverage for addiction treatment may vary. The length of time you spend in rehab will depend on your individual needs as well as your particular plan coverage.

Research shows that most people with addiction to alcohol or drugs need at least 3 months in treatment to significantly reduce or stop their substance abuse; longer treatment times are associated with better outcomes.7

You can look up your Oxford Health plan information on the member portal to learn how many days of treatment are covered in a calendar year by your plan. Or call the number on the back of your insurance card to learn more about what your specific plan covers for drug and alcohol rehab. Alternatively, you can call Oxford’s Behavioral Health (BEH) Department with any questions you have about treatment coverage and the length of days covered. The office handles pre-authorization forms, referrals, and case management for Oxford members. They can be reached at 1-800-201-6991.

What if My Oxford Health Policy Does Not Cover Rehab?

As an Oxford Health member, at least some of your treatment should be covered by your insurance plan. However, it’s important to seek treatment as soon as you’re ready even if your Oxford Health plan does not cover all of your treatment expenses. Don’t let costs hold you back from getting and staying sober. Getting treatment saves lives.

Should you have out-of-pocket expenses beyond what Oxford Health covers, there are various options to consider:

  • Payment plans. These are often offered by rehab centers so you can gradually pay back your costs over time.
  • Scholarships and grants. These may be provided by the rehab center or at a local or federal government level.
  • Asking family and friends for donations and financial support

If you have questions about your payment options, talk with an admissions navigator at the rehab center you are considering. They can verify your insurance for you over the phone to determine what your plan will cover and help you come up with a plan to cover your out-of-pocket expenses.

Oxford Health In-Network vs. Out-of-Network Drug Rehab Centers

In your search for a rehab center, you’ve likely seen a lot about “in-network” and “out of network.” Understanding the differences can help you make a decision and cut down on your out-of-pocket expenses.

A facility that is in-network has an agreement with Oxford Health. They are within the Oxford Health network to provide treatment services at a discounted rate. Out-of-network means that the rehab center does not have an agreement with Oxford Health. The difference in cost of an in-network facility versus an out-of-network can be staggering. Selecting a center that is within the Oxford Health network is a wise financial decision. American Addiction Centers is in-network with Oxford Health.

In some cases, Oxford Health may cover an out-of-network treatment facility. You will need pre-authorization from the insurance company and a healthcare provider for out-of-network coverage to kick in.4 Oxford Health prefers their members to stay in-network, not only to help keep costs down but to ensure that treatment is provided by an approved treatment facility that uses evidence-based treatments for the best outcomes.

Check Oxford Health Coverage for Addiction Treatment

Before you select a rehab facility to attend, check your Oxford Health policy benefits to determine which costs will be covered by your provider and which will be out-of-pocket for you. When you know what to expect financially, you can focus on what truly matters: your sobriety.

To check your insurance benefits, call the number on the back of your insurance card to speak with an Oxford Health customer service representative. They will verify your benefits for you and walk you through what is covered (and what isn’t) in detail.

Alternatively, American Addiction Centers can verify your insurance coverage for you. Call our helpline at to speak to an admissions specialist who can check your benefits while you’re on the phone. You can also complete the form below to enter your information and see immediately if the center you are considering is in-network with Oxford Health.

American Addiction Centers has treatment centers in the Northeast region of the United States. These are some of the best facilities in the nation. A few within the Oxford Health network offer evidence-based, personalized treatments:

AdCare Treatment Hospital in Massachusetts

AdCare Inpatient Facility in Rhode Island

AdCare Hospital Outpatient Facility in Massachusetts

AdCare Outpatient Facility in Rhode Island

Sunrise Treatment House in New Jersey