Oscar Drug and Alcohol Rehab in Ohio

Will Oscar Pay For Rehab?

Yes, Oscar will cover at least a portion of drug or alcohol rehab. Thanks to the Affordable Care Act, health insurance providers, including Oscar, are required by federal law to offer coverage for addiction treatment as an essential health benefit. 

However, which services and facilities are covered will vary from member to member. Your Oscar coverage for addiction services will depend on:

• The specifics of your individual Oscar policy
• The severity of your addiction
• Which substances are involved
• Network status of the facility (in or out-of-network)
• Inpatient vs outpatient

Occasionally, Oscar may not approve a claim for inpatient rehab and will suggest another level of care instead. At OARC, our medical team conducts a bio-psycho-social assessment to determine your eligibility for inpatient treatment. If inpatient rehab is determined to be beneficial, we work with Oscar to ensure your coverage is approved.

When you are approved for drug or alcohol rehab, your out-of-pocket costs, if any, are determined by your plan.

Types of Oscar Plans

Oscar offers plan types like other insurance providers such as HMO, PPO, POS, and EPO. These plan types determine whether you must choose an in-network rehab and your out-of-pocket costs for treatment. Oscar plans often have metal tiers to simply plan comparison.

Secure – Oscar Secure plan is designed for healthy members under 30 who just want emergency coverage and rarely go to the doctor. This is also referred to as catastrophic coverage and is usually a high-deductible plan. In exchange for a lower monthly premium, members are responsible for more costs at the time of care. For rehab, members usually need to cover their annual deductible.

Bronze – Oscar Bronze plans are similar to Secure with lower premiums and a high deductible, but offer better coverage at the time of care. These plans are also intended for healthy people who don’t see the doctor often. For rehab, Bronze members usually will be responsible for their deductible.

Silver – Oscar Silver is their “in-between” plan that splits member cost-sharing between their premium and deductible, copays, or coinsurance. For rehabilitation, members may have cost-sharing fees, but generally Oscar pays for the majority of care.

Gold & Platinum – Oscar Gold and Platinum plans offer the most flexibility with the lowest out-of-pocket costs at the time of care. Because these plans have a higher monthly premium, members will have little or no out-of-pocket costs for inpatient addiction treatment.

Regardless of your plan, staying in-network will always have the lowest out-of-pocket costs. 

If you’re not sure where your plan falls or what out-of-pocket costs you may have for treatment, we encourage you to call us at 800-481-8457. This is the best way to understand your benefits and if treatment will be covered with us. We often work with clients to ensure out-of-pocket costs are not a barrier to their care.

Rehab Services Covered By Oscar at OARC

At Ohio Addiction Recovery Center, we offer a full continuum of care in-network with Oscar. Our facility in Columbus, OH offers:

Medical Detox – Often the first step in an addiction treatment plan, medical detox is an intensive inpatient level of care to manage the symptoms of drug or alcohol withdrawal. Our detox program is 7-14 days with 24-hour nursing and medication management. Detox ensures a safe and comfortable withdrawal process. Learn more about our detox center in Columbus.

Residential Rehab – While detox treats the physical aspect of addiction, residential rehab treats the psychological component. In our 30-45 day program, clients address the underlying causes of their substance use and learn new coping skills. Clients engage in evidenced-based psychotherapy, classes, and activities. Learn more about our inpatient rehab in Columbus.

Partial Hospitalization (PHP) – With similar programming as residential treatment, clients engage full-time in addiction treatment. Instead of staying at the facility overnight, clients return home or to their halfway house. Some clients step down to PHP from residential treatment to extend their care while still utilizing their insurance coverage. Learn more about PHP.

Intensive Outpatient (IOP) – IOP is an aftercare program for our clients who first complete residential or PHP. IOP is 3 days per week in the evenings, so clients can start to transition back to work, school, or their home life. Learn more about our IOP in Columbus.

Oscar Mental Health Coverage

At OARC, we believe mental health is inherently intertwined with addiction. In fact, it’s estimated at least 50% of individuals with a substance use disorder have another co-occurring mental health disorder, such as anxiety, depression, or trauma. Our program includes dual-diagnosis care to diagnose and treat any possible co-occurring conditions. Clients have the opportunity to meet with psychiatric medical providers to address mental health concerns, all utilizing their Oscar benefits.

Understanding Your Oscar Rehab Coverage

We understand insurance can be overwhelming or downright confusing. We’re committed to providing friendly and transparent customer service to anyone who reaches out for help. Through our toll-free helpline, you or your loved one can check your Oscar coverage and learn about your options with no obligation. You can reach us at 800-481-8457.

• Sources

  1. Oscar – About Us
  2. Oscar – Compare Health Plans