OSCAR
Oscar Coverage for Addiction Treatment in Albany, NY
Don’t let insurance questions get in the way of recovery. At Fusion Recovery in Albany, NY, our admissions team will verify your Oscar Health benefits, explain what’s covered in plain language, and help you start treatment, often the same day.
START HEALING TODAY
Personalized Outpatient Treatment for Albany Residents
At Fusion Recovery, we understand the weight that addiction places on your life and the lives of those you love. That’s why we offer personalized outpatient addiction treatment built around your specific situation, your goals, your schedule, and your recovery needs.
As an outpatient rehab serving the Albany, NY region, we provide flexible scheduling so you can stay engaged with work, family, and other commitments while getting the help you deserve. Our team blends evidence-based therapies with medication-assisted treatment, clinical counseling, and holistic support to help you build a lasting recovery.
If you or someone you love is struggling, contact us today. Our admissions team will verify your Oscar benefits, walk you through your treatment options, and help you take the next step at no cost and with no pressure.
ABOUT OSCAR
Understanding Oscar Health Coverage
Oscar Health is a technology-focused health insurance company founded in New York City in 2012. Built around a digital-first member experience, with a member app, virtual care options, and transparent benefit displays, Oscar has grown to serve more than 1 million members across 18 states, including New York. The company is headquartered in New York City and continues to play a meaningful role in the state’s individual and family insurance market.
Oscar primarily offers Individual and Family health insurance plans through the NY State of Health marketplace, along with Small Group plans for businesses and limited Medicare Advantage offerings. Most Oscar plans use HMO or EPO networks, which means in-network providers are typically required for coverage. For Albany-area residents, Oscar coverage is most often a Qualified Health Plan purchased through NY State of Health.
For behavioral health and substance use disorder care, Oscar partners with Optum (United Behavioral Health) to administer mental health and addiction treatment benefits. This means that even though your medical insurance card displays Oscar, the behavioral health portion of your benefits, including network access, prior authorizations, and claims processing, is managed by Optum.
Under the Mental Health Parity and Addiction Equity Act, Affordable Care Act, and New York State Insurance Law, Oscar plans must cover mental health and substance use treatment at the same level as physical health services. New York State Insurance Law adds further protections, including up to 28 days of inpatient substance use treatment at NY OASAS-licensed facilities for members with a primary substance use disorder diagnosis.
OVERVIEW OF OSCAR BENEFITS
What Oscar Covers at Fusion Recovery
Coverage details vary by plan and metal tier, but most Oscar plans cover a comprehensive range of addiction treatment services.
Treatment services typically covered
- Medically managed and medically monitored detoxification
- Outpatient rehab and intensive outpatient programs (IOP)
- Partial hospitalization programs (PHP)
- Individual, group, and family therapy
- Medication-assisted treatment (MAT), including Sublocade and Suboxone
- Dual diagnosis care for co-occurring mental health conditions
- Crisis stabilization and mobile crisis services
- Aftercare planning and continued outpatient support
- Virtual visits with therapists and providers through Oscar’s app
Coverage details and metal tiers
Oscar plans on the NY State of Health marketplace are organized into metal tiers, Bronze, Silver, Gold, and Platinum, which determine how costs are shared between you and the plan. Members on Platinum plans typically have the lowest out-of-pocket costs, while Bronze plans have the lowest premiums but higher cost-sharing. Subsidies through the marketplace can significantly reduce premium costs for eligible members. Our admissions team will verify your specific benefits and explain expected costs before treatment begins.
In-network requirement
Most Oscar plans use HMO or EPO networks, which means treatment must typically be received from an in-network provider for coverage to apply. Out-of-network care is generally not covered except in emergencies. This makes verifying network status before treatment particularly important, and Fusion Recovery’s admissions team handles this for you.
Preauthorization through Optum
Because Oscar partners with Optum for behavioral health, prior authorization for medical detox, residential treatment, partial hospitalization, and intensive outpatient programs is generally routed through Optum Behavioral Health. Standard outpatient services typically don’t require prior authorization for in-network providers. Optum uses the American Society of Addiction Medicine (ASAM) Criteria for medical necessity decisions on substance use disorder care. Fusion Recovery handles authorizations and continued-stay reviews on your behalf.
Call Now to Verify Your Coverage
HOW IT WORKS
How to Verify Your Oscar Benefits
Verification is fast, free, and fully confidential. Here’s how it works:
01.
Share your details
Call us at 1.866.936.2290 or fill out our contact form with your Oscar member ID and group number, plus your plan type (HMO, EPO, Bronze, Silver, Gold, or Platinum) if known.
02.
We verify your benefits
Our team contacts both Oscar and Optum (United Behavioral Health) to confirm in-network status, deductibles, copays, prior authorization requirements, and what level of care is covered under your plan.
03.
We explain your options
We walk you through your benefits in plain language, outline any out-of-pocket costs, and recommend the level of care that fits your needs.
04.
You take the next step
When you’re ready, we schedule your clinical assessment and help you begin treatment, often the same day.
WHAT WE TREAT
Conditions We Treat at Fusion Recovery
Our Albany, NY treatment programs serve adults struggling with a wide range of substance use and co-occurring mental health conditions, including :
- Alcohol use disorder
- Opiate and prescription painkiller addiction
- Heroin addiction
- Fentanyl addiction
- Cocaine addiction
- Methamphetamine addiction
- Benzodiazepine dependence
- Co-occurring depression, anxiety, PTSD, and other mental health conditions
Ready to Take the First Step?
Recovery begins when you reach out. Our admissions team is available to verify your Oscar coverage, navigate the Optum authorization process, and help you start treatment in Albany, NY. Call anytime, we’re here when you’re ready.
Frequently Asked Questions
01. Is Fusion Recovery in-network with Oscar?
Fusion Recovery may be in-network with Oscar plans serving Albany, NY, and the surrounding Capital Region. Because most Oscar plans require in-network providers for coverage to apply, network verification is especially important. Call our admissions team at 1.866.936.2290 to confirm your in-network benefits before starting treatment.
03. What does Oscar cover for addiction treatment?
Oscar plans typically cover the full continuum of substance use treatment, including medical detox, residential treatment, partial hospitalization (PHP), intensive outpatient programs (IOP), standard outpatient care, individual and group therapy, medication-assisted treatment, and dual diagnosis care. As an ACA-compliant plan, all Oscar coverage includes substance use disorder treatment as an essential health benefit.
05. How do Oscar's metal tiers affect my addiction treatment coverage?
All Oscar metal tiers (Bronze, Silver, Gold, Platinum) cover substance use disorder treatment as part of essential health benefits, but the cost-sharing differs significantly. Platinum plans cover roughly 90% of expected costs, Gold around 80%, Silver around 70%, and Bronze around 60%. Members enrolled in Silver-tier plans through NY State of Health may also qualify for cost-sharing reductions that lower out-of-pocket costs further.
07. Will I have to pay anything out of pocket?
Out-of-pocket costs depend on your specific Oscar plan, your deductible, and any copays or coinsurance under your policy. Members enrolled through NY State of Health may qualify for federal subsidies that reduce premium costs and, for Silver-tier plans, cost-sharing reductions that lower deductibles and copays. Our admissions team will give you a clear picture of expected costs before treatment begins.
09. Will my employer or family find out I'm seeking treatment?
Federal law (HIPAA and 42 CFR Part 2) provides strong confidentiality protections for substance use treatment records. Your employer is not notified, and Oscar (or Optum, on Oscar’s behalf) cannot share your treatment details with anyone without your written authorization.
02. My Oscar card mentions Optum or United Behavioral Health. Why?
Oscar partners with Optum (United Behavioral Health) to administer mental health and substance use disorder benefits. While your medical insurance card shows Oscar, the behavioral health portion of your benefits is managed by Optum. This means authorizations and claims for addiction treatment are processed through Optum’s network and clinical review systems.
04. Does Oscar cover MAT medications like Suboxone and Sublocade?
Yes. Oscar plans typically cover FDA-approved medication-assisted treatment medications, including Sublocade and Suboxone for opioid use disorder, as well as naltrexone and Vivitrol for opioid and alcohol use disorders. Some medications may require prior authorization, which our admissions team handles for you. Under New York Insurance Law changes, prior authorization is generally not required for medications used to treat substance use disorder.
06. How long will Oscar cover inpatient treatment in New York?
Under New York State Insurance Law, fully insured Oscar plans must approve up to 28 days of inpatient substance use treatment at a NY State Office of Addiction Services and Supports (OASAS)-licensed facility for members with a primary substance use disorder diagnosis. Coverage past 28 days is reviewed by Optum using the ASAM Criteria based on your progress and ongoing clinical need.
08. Do I need a referral from my primary care doctor?
Most Oscar plans don’t require a referral for behavioral health and substance use treatment, even on HMO products. However, in-network status is required for coverage to apply on most plans. Our admissions team will check the requirements for your specific plan during the verification process.
10. What if Oscar denies coverage for my treatment?
Don’t give up. Because Oscar’s behavioral health benefits are administered by Optum, denials and appeals typically go through Optum’s appeal process, which includes multiple levels of internal review and the option for a peer-to-peer review with an Optum medical director. Federal and state parity laws require insurers to cover behavioral health at the same level as medical care. New York residents can also file a complaint with the New York State Department of Financial Services at 1-800-400-8882.
01. Is Fusion Recovery in-network with Oscar?
Fusion Recovery may be in-network with Oscar plans serving Albany, NY, and the surrounding Capital Region. Because most Oscar plans require in-network providers for coverage to apply, network verification is especially important. Call our admissions team at 1.866.936.2290 to confirm your in-network benefits before starting treatment.
02. My Oscar card mentions Optum or United Behavioral Health. Why?
Oscar partners with Optum (United Behavioral Health) to administer mental health and substance use disorder benefits. While your medical insurance card shows Oscar, the behavioral health portion of your benefits is managed by Optum. This means authorizations and claims for addiction treatment are processed through Optum’s network and clinical review systems.
03. What does Oscar cover for addiction treatment?
Oscar plans typically cover the full continuum of substance use treatment, including medical detox, residential treatment, partial hospitalization (PHP), intensive outpatient programs (IOP), standard outpatient care, individual and group therapy, medication-assisted treatment, and dual diagnosis care. As an ACA-compliant plan, all Oscar coverage includes substance use disorder treatment as an essential health benefit.
04. Does Oscar cover MAT medications like Suboxone and Sublocade?
Yes. Oscar plans typically cover FDA-approved medication-assisted treatment medications, including Sublocade and Suboxone for opioid use disorder, as well as naltrexone and Vivitrol for opioid and alcohol use disorders. Some medications may require prior authorization, which our admissions team handles for you. Under New York Insurance Law changes, prior authorization is generally not required for medications used to treat substance use disorder.
05. How do Oscar's metal tiers affect my addiction treatment coverage?
All Oscar metal tiers (Bronze, Silver, Gold, Platinum) cover substance use disorder treatment as part of essential health benefits, but the cost-sharing differs significantly. Platinum plans cover roughly 90% of expected costs, Gold around 80%, Silver around 70%, and Bronze around 60%. Members enrolled in Silver-tier plans through NY State of Health may also qualify for cost-sharing reductions that lower out-of-pocket costs further.
06. How long will Oscar cover inpatient treatment in New York?
Under New York State Insurance Law, fully insured Oscar plans must approve up to 28 days of inpatient substance use treatment at a NY State Office of Addiction Services and Supports (OASAS)-licensed facility for members with a primary substance use disorder diagnosis. Coverage past 28 days is reviewed by Optum using the ASAM Criteria based on your progress and ongoing clinical need.
07. Will I have to pay anything out of pocket?
Out-of-pocket costs depend on your specific Oscar plan, your deductible, and any copays or coinsurance under your policy. Members enrolled through NY State of Health may qualify for federal subsidies that reduce premium costs and, for Silver-tier plans, cost-sharing reductions that lower deductibles and copays. Our admissions team will give you a clear picture of expected costs before treatment begins.
08. Do I need a referral from my primary care doctor?
Most Oscar plans don’t require a referral for behavioral health and substance use treatment, even on HMO products. However, in-network status is required for coverage to apply on most plans. Our admissions team will check the requirements for your specific plan during the verification process.
09. Will my employer or family find out I'm seeking treatment?
Federal law (HIPAA and 42 CFR Part 2) provides strong confidentiality protections for substance use treatment records. Your employer is not notified, and Oscar (or Optum, on Oscar’s behalf) cannot share your treatment details with anyone without your written authorization.
10. What if Oscar denies coverage for my treatment?
Don’t give up. Because Oscar’s behavioral health benefits are administered by Optum, denials and appeals typically go through Optum’s appeal process, which includes multiple levels of internal review and the option for a peer-to-peer review with an Optum medical director. Federal and state parity laws require insurers to cover behavioral health at the same level as medical care. New York residents can also file a complaint with the New York State Department of Financial Services at 1-800-400-8882.
Disclaimer: The information provided on this website regarding insurance coverage is only a summary. It does not include all limitations, exclusions, or qualifiers that may apply to your actual coverage. Please refer to your health plan's Evidence of Coverage or Summary Plan Description for full details. Treatment services must be medically necessary to be covered. Any treatment decisions must be discussed with your health provider. We cannot guarantee any coverage or reimbursement. Please contact your health plan directly for the most accurate information regarding your benefits.
Take the first step
Providing hope to all. Compassionate outpatient care for our community. Ready to talk?
Recovery begins when you reach out. Questions?
Call anytime to speak with an Admissions
Specialist, or request a consultation and we’ll follow up.
David Sietz, M.D.
Chief Medical Officer, Fusion Recovery
Email us or Call
Contact Form
"(Required)" indicates required fields
Start Healing Today
At Fusion Recovery, we understand the difficulties that addiction can bring into your life. That’s why we offer personalized outpatient addiction treatment tailored to your unique needs. As an outpatient rehab facility, we provide flexible scheduling so you can continue your work, family life, and other commitments while getting the help you deserve.
Fusion Recovery proudly accepts Oscar coverage for addiction treatment services including outpatient rehab, therapy, medication-assisted treatment, and more. Our compassionate team of experts will verify your Oscar benefits, take care of claims, and make insurance processes smooth. More importantly, we’ll craft an individualized treatment plan using evidence-based therapies and holistic methods to facilitate your lifelong recovery.
With Fusion Recovery, you can find judgment-free support and healing in a comfortable environment. Our welcoming facility and amenities create a peaceful space for you to focus on your recovery journey. If you or a loved one is struggling with addiction, contact us today to learn more about Oscar coverage and how we can help you get your life back.
Overview of Oscar Benefits
Fusion Recovery is in-network with Oscar plans.
Treatment services covered
Oscar covers services like outpatient rehab, individual therapy, group therapy, medication management, and aftercare support. Our team can help verify your coverage and explain your options before starting treatment so you know what to expect.
Coverage details
Coverage details vary by individual Oscar plan. Out-of-pocket costs such as copays, deductibles, and coverage levels depend on your specific benefits. Our team can help verify your coverage and explain your options before starting treatment.
Preauthorization requirements
Prior authorization may be required for medication-assisted treatment and intensive outpatient programs. Fusion Recovery can assist with obtaining authorizations.
CALL NOW
Safe and Effective
Verify Your Insurance Coverage.
Remember, the specifics of coverage can vary based on your individual plan and location. It’s always a good idea to confirm coverage with both your insurance provider and Fusion Recovery.
What We Treat
Alcohol Treatment
Alcohol is widely available, which can make harmful patterns harder to spot early.
Heroin Treatment
Heroin is a fast-acting opioid that can quickly reshape the brain and body.
Fentanyl Treatment
Fentanyl is a potent synthetic opioid linked to high overdose risk, even at small amounts.
Disclaimer: The information provided on this website regarding insurance coverage is only a summary. It does not include all limitations, exclusions, or qualifiers that may apply to your actual coverage. Please refer to your health plan’s Evidence of Coverage or Summary Plan Description for the full details and specifics of your benefits. Treatment services must be medically necessary to be covered by your health plan. Whether a treatment or service is medically necessary will be determined based on a review of clinical information provided by your provider. Any treatment decisions must be discussed and determined in conjunction with your health provider. We cannot guarantee any coverage or reimbursement. Please contact your health plan directly for the most accurate and up-to-date information regarding your benefits and coverage for addiction treatment services.
Take the first step
Providing hope to all. Compassionate outpatient care for our community. Ready to talk?
Recovery begins when you reach out. Questions?
Call anytime to speak with an Admissions
Specialist, or request a consultation and we’ll follow up.
David Sietz, M.D.
Chief Medical Officer, Fusion Recovery
Email us or Call
Contact Form
"(Required)" indicates required fields
