CAM > ACCESSING ALTERNATIVE CARE

Accessing Alternative Care

Contracted Rate: Oxford has negotiated contracted rates with all of our network CAM providers in Connecticut, New Jersey and New York. These rates vary by specialty and region, and in most instances reflect a discount from the provider's normal fee. Our commercial and Medicare Members can simply select an Oxford participating CAM provider, schedule an appointment, and pay the Oxford-negotiated rate to the provider at the time of the visit. This is not an insured benefit, so there is no need for a primary care physician (PCP) referral or additional paperwork.

Standard In-Network Benefits2: Members whose plan includes standard benefits for naturopathic coverage (available to groups underwritten in CT) and chiropractic coverage can visit any chiropractor or naturopath3 in Oxford's CAM network for medically necessary care. Members need a PCP referral and are responsible for a copayment at the time of the visit. Precertification is required for any visits after the initial visit.

Out-of-Network Benefits2: Point-of-service (POS) Members have access to out-of-network benefits for medically necessary chiropractic coverage. Some Connecticut POS Members have access to out-of-network benefits for medically necessary naturopathic coverage. POS Members do not need a PCP referral to visit a chiropractor or naturopath3, but are subject to deductible and coinsurance requirements and usual customary and reasonable (UCR) charges limitations.

Alternative Medicine Rider: If a Member's employer has purchased the Alternative Medicine Rider, the Member is entitled to access participating chiropractors, acupuncturists, and naturopaths3 (available to groups underwritten in CT) for medically necessary care. Members with this rider do not need a PCP referral and are responsible for a copayment at the time of the visit. Precertification is required for any visits after the initial number of visits set forth in the rider. The rider replaces any applicable standard in-network chiropractic or naturopathic benefit. Rider availability differs by region, employer company size, and plan design.

1 Providers vary by state.
2 Benefits may vary by state and product. Check your Certificate of Coverage for the specifics of your plan.
3 Connecticut is the only state in our service area that licenses naturopathic physicians.


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