Oscar Coverage for Mental Health & Addiction Treatment
Members of Oscar Health may be eligible for coverage for drug rehab, alcohol rehab, mental health care, and recovery. Although it is not guaranteed, it is a good idea to review your benefits for Oscar health insurance before seeking treatment.
What Oscar members should know
- Verify Coverage Quickly
- No Obligation
- Confidential
Does Oscar Cover Drug & Alcohol Rehab?
Oscar health insurance plans usually have behavioral health services and substance abuse services included in the plans. The Affordable Care Act includes mental health services and substance abuse services as essential health benefits.
Oscar rehab services may vary based on whether the rehab facility is an in-network provider, the type of health plan an individual or family enrolls in with Oscar, and the extent of the rehab service required. Services such as inpatient rehab and medical detox may require prior authorization and/or be subject to medical necessity reviews.
Oscar offers individual and family health plans in some states, and the extent of the health plan may vary.
Which Addiction Treatment Services May Be Covered by Oscar?
There are several services provided through insurance plans offered by Oscar Health that can be beneficial for someone who is looking to overcome their addiction.
Medical Detox
Medical detox is usually the first step in treating substance abuse problems, especially when the individual needs to go through withdrawal from the substance he or she is using.
Inpatient / Residential Rehab
Inpatient or Residential care is a highly structured environment with 24/7 support, usually reserved for those with more severe addictions or co-occurring conditions. The extent of the coverage varies according to the plan.
Partial Hospitalization Programs (PHP)
Partial hospitalization programs offer significant therapy during the day but permit patients to return home at night. Some of the Oscar plans offer coverage for PHP services, which serve as a step-down from inpatient services.
Intensive Outpatient Programs (IOP)
Intensive outpatient services offer therapy several days per week but do not require patients to stay overnight. This type of coverage is offered when inpatient services are not medically necessary.
Standard Outpatient Treatment
Outpatient rehabilitation services may include individual or group therapy sessions as well as recovery support services. Mental health and substance abuse treatment may be included in the Oscar insurance plan.
Aftercare/ Continuing Care
Services provided in aftercare include prevention of relapse, further therapy, and recovery support. This is subject to the type of policy and continued medical necessity.
Telehealth Intensive Outpatient Programs (IOP)
Oscar health plans may offer tele-mental health visits and virtual IOP services when medically necessary. Telehealth programs enable patients to receive structured addiction and mental health services through secure online visits. Banyan Treatment Center can verify your Oscar health coverage and check your eligibility for telehealth services.
Note: Determination of length of stay and type of care is usually based on medical necessity.
Does Oscar Cover Mental Health Treatment & Therapy?
Oscar health insurance plans typically include coverage for mental health services, which may be integrated with addiction treatment.
Coverage may include:
- Individual and family therapy
- Group therapy
- Treatment for depression, anxiety, and other mental health disorders
- Support for co-occurring mental health conditions
- Group and family therapy
- Co-occurring disorder treatment
- Ongoing mental health support
Some Oscar plans may also offer coverage for prescription medications as well as psychiatry and medication management.
Inpatient Mental Health Coverage
Some Oscar health plans may offer inpatient mental health coverage or residential care in cases where the mental health symptoms are severe to the point that they need to be supervised.
How Much Does Rehab Cost With Oscar?
The price of rehab with Oscar varies depending on the insurance plan and the network status of the individual. Even if the individual has Oscar insurance, there may still be out-of-pocket costs for the individual, such as copays and deductibles.
Factors That Affect Your Out-of-Pocket Cost
- In-network vs. out-of-network providers
- Deductibles, copays, and coinsurance
- Prior authorization and medical necessity review
- Level of care (detox, inpatient, outpatient rehab)
- Specific Oscar plan structure
What You Can Do Right Now
We at Banyan Treatment Center can assist in verifying your benefits with your Oscar health insurance provider. Additionally, we can help you understand your insurance options prior to admission. In some instances, we can also help you better understand the costs involved.
If You Call Oscar Directly, Ask:
- Is medical detox covered?
- Are inpatient or residential programs covered under my plan?
- Is PHP or intensive outpatient programs covered?
- Do I need prior authorization?
- Is this facility in-network?
- What are my deductibles, copays, and coinsurance?
- Are there limits on the number of treatment days or sessions?
Or, We Can Verify for You (Recommended)
- We contact your insurance provider directly
- We review coverage details and medical necessity requirements
- We explain the benefits clearly and confidentially
How to Find Treatment That Accepts Oscar
“Accepting” Oscar may refer to the facility being an in-network provider or offering an out-of-network choice, depending upon the plan. The details vary by state.
Getting Matched to the Right Level of Care
The assessment will help identify the best course of treatment depending on the severity of the substance abuse and mental health problems, as well as insurance coverage.
Next Steps: Verify your Oscar coverage or speak with an admissions specialist today.
Frequently Asked Questions
The following Banyan Treatment Center locations accept Oscar insurance plans. Please note that the acceptance of Oscar insurance plans is subject to change. It is always best to verify with the insurance company.
- Banyan Sebring
1062 Lake Sebring Dr
Sebring, FL 33870 888-659-7463 - Banyan Gulf Breeze
4400 Hickory Shores Blvd
Gulf Breeze, FL 32563 800-508-0119 - Clearbrook Pennsylvania
1100 E Northampton St
Laurel Run, PA 18706 570-405-9934 - Banyan Heartland
1237 E 1600 North Rd
Gilman, IL 60938 877-973-7262
Coverage varies by Oscar plan and state. Insurance verification is required to confirm eligibility and benefits.
Verify Your Oscar Insurance Benefits Today
The specifics of the coverage will depend on the type of plan and the location. Banyan Treatment Center is available to assist you in understanding your Oscar health insurance plan as well as the best course of action for your addiction or mental health treatment.
Banyan Facilities for Drug, Alcohol, & Mental Health Treatment
Banyan Castle Rock
Located in Castle Rock, CO
Substance Use Inpatient
Mental Health Inpatient
Telehealth Virtual IOP
Banyan Heartland
Located in Gilman, IL
Substance Use Inpatient
Mental Health Inpatient
Substance Use Outpatient
Telehealth Virtual IOP
Banyan Palm Springs
Located in Cathedral City, CA
Substance Use Inpatient
Telehealth Virtual IOP
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