Luck has nothing to do with it. Complementary & Alternative Medicine Guide 5584 MS-02-616 2003 Oxford Health Plans, Inc.
You say tomato. I say tomato. Oxford recognizes the obvious fact that people are different. And what s right for one Member may not be the best option for another. Realizing there will never be a single path to wellness, we always provide our Members with plenty of choices. In 1997, we were one of the first major health plans to offer a Complementary & Alternative Medicine (CAM) Program. No matter which path you choose to achieve wellness, Oxford provides you access to quality care through a network of credentialed providers. Today, Oxford Members have access to a vast network of board-certified doctors as well as a credentialed network of over 2,400 complementary and alternative medicine providers in Connecticut, New Jersey and New York. That means all of our participating providers meet state license and malpractice requirements, as well as clinical experience requirements. Each provider must also be recredentialed once every three years and must be committed to continuing education in his or her discipline. Because we believe that alternative care should complement traditional care rather than replace it, we encourage close communication between CAM providers, Members, primary care physicians (PCPs) and any other specialist who may be involved in providing care. For instance, when a Member shares the details of his or her CAM treatments and medicine use with a PCP, the PCP can look for potential interactions with conventional medicine, monitor progress, and possibly integrate the CAM treatments into the Member s medical treatment plan. Please read further to learn about all of Oxford s Complementary & Alternative Medicine Program benefits and how they may be helpful to you. complementary & alternative medicine Oxford Health Plans
All Oxford Members have access to the CAM Program Contracted Rate: You can visit any of Oxford s CAM providers without a PCP referral, at a specially negotiated rate. Simply select a participating provider, schedule an appointment, and pay the provider at the time of the visit. This is not an insured benefit, so there is no need for a PCP referral, PCP reimbursement, or paperwork. In most cases, this rate reflects a discount from the provider s normal fee. Standard In-Network Benefits: For medically necessary care, if your plan includes standard benefits for chiropractic and naturopathic (Connecticut only) coverage, you are required to obtain a referral for the initial visit. Precertification is required for any visits after the initial visit.* You will be responsible for a copayment at the time of the visit. Members of non-gated plans are not required to obtain referrals to participating chiropractors or naturopaths (Connecticut only). Alternative Medicine Rider: If your employer has purchased the alternative medicine rider, you can make medically necessary initial visits (subject to a copayment) to participating chiropractors, acupuncturists, and naturopaths (available to groups underwritten in Connecticut only) without a PCP referral. Precertification is required for any visits after the initial visit. The rider replaces any applicable standard in-network chiropractic or naturopathic benefit. Rider availability differs by region, employer, company size, and plan design. *If you have out-of-network coverage and access chiropractic care through a non-participating provider, the services will be reviewed for medical necessity. Members and providers can either: 1) Request prior approval through TRIAD by submitting the Voluntary Prior Approval Agreement Form along with an Initial Care Plan Form; or CAM features you ll find at www.oxfordhealth.com Our web site is designed to give you convenience and options. Interact with us wherever you want, whenever you want, 24 hours a day, seven days a week (excluding periodic downtimes for maintenance). You can search for a CAM provider, change your primary care physician, check the status of a claim, and learn how to access the CAM Program. All you have to do is log in to www.oxfordhealth.com and access the oxfordhealth Center from your personalized account page. You ll receive an abundance of information about our Complementary & Alternative Medicine Program. Some of the newest features within the CAM section include the following: ConsumerLab.com Oxford has recently contracted with ConsumerLab.com, a site that offers independent information and test data on vitamins, herbs and minerals, supplements, and natural products. In addition to test results, Members can get information on recalls and warnings, new product reviews, and drug interactions, gain access to the Natural Pharmacist Encyclopedia, and sign up for a free newsletter. CAM Connection The CAM Connection is where traditional medicine meets complementary medicine. Our site provides a link to dialogue from a roundtable forum on medical topics of interest. In this forum, conventional and CAM doctors share their perspectives on the patient s role in managing health and exploring avenues for care. For example, if the medical topic was cardiac wellness, panelists may talk about how achieving and maintaining cardiovascular health starts with prevention. Panelists may also try to get Members to understand how lifestyle awareness, proper nutrition, and health education contribute to cardiac wellness. 2) Submit clinical notes for medical necessity review to TRIAD after services are rendered and claims are submitted.
Choosing a Complementary & Alternative Medicine Provider Ways to find a CAM provider: Review your Oxford Roster of Participating Physicians and Providers Access the online Doctor Search tool at www.oxfordhealth.com Call Customer Service at the number on your Oxford ID card, or at 800-444-6222 For more information about Oxford s Complementary & Alternative Medicine Program, visit Oxford s web site at www.oxfordhealth.com, or call Customer Service at the number on your Oxford ID card or at 800-444-6222. For a hearing impaired interpreter, you may call Oxford s TTY/TDD line at 800-201-4875. It s nice to have choices. Especially when it comes to your health plan. Acupuncture. Massage Therapy. Yoga. When you hear these words, do you think about your health plan? Probably not. But you should. Oxford Health Plans Complementary & Alternative Medicine (CAM) Program offers you discounted rates from a comprehensive network of providers, which includes acupuncturists, yoga instructors, massage therapists, chiropractors, nutritionists and naturopaths (Connecticut only). ACUPUNCTURE Acupuncture is based on the theory that life energy, called Qi (pronounced chee ), flows through the body. Any interruption of this energy flow could cause problems such as back pain, insomnia, or even migraines. Acupuncturists help restore the proper flow of Qi by inserting thin needles into specific points on the body, thereby releasing natural healing energies. Acupuncture may help with: Allergies Asthma Joint pain Colds and flu Depression Dental and facial pain Infertility Gynecological disorders PMS Stress
YOGA Yoga may help with: CHIROPRACTIC Chiropractic may help with: Yoga practitioners have been bending themselves into pretzel-like positions for more than 5,000 years. The word yoga means to yoke together, joining body and mind through exercise, breathing, and meditation. Yoga has been proven to help reduce stress, lower blood pressure, and even help insomnia. Addictions Chronic obstructive pulmonary conditions Sciatica Constipation Gastrointestinal problems Depression Migraines Heart disorders Menstrual disorders Obesity The chiropractic approach to healthcare emphasizes your overall health. Chiropractic practitioners analyze and locate the source of nerve interference associated with the body s muscular, nervous, and skeletal systems, especially the spine. They believe interference with these systems impairs normal functions and lowers resistance to disease. Through often-simple adjustments to the spine and joints, chiropractors help the body s natural healing powers alleviate pain and promote improved overall health. Low back pain Headaches Fatigue Stiff neck Asthma Irritable bowel syndrome Childhood ear infections NUTRITION Nutrition may help with: MASSAGE THERAPY Massage Therapy may help with: It s been proven that individual nutrients aid in the prevention and treatment of many diseases. For example, getting enough of certain vitamins, minerals and naturally occurring health-protective compounds called phytonutrients has been shown to protect against the development of heart disease, cancer, and other ailments. Nutritionists help prevent illnesses by promoting healthy eating habits, scientifically evaluating patients diets, and recommending diet modifications. Cholesterol Energy levels Sleep Stamina Skin Hair Digestion Acne PMS Prostate trouble Whether you re seeking relief for a medical condition, dealing with stress, or simply trying to maintain good health, therapeutic massage may be your answer. Besides just feeling really good, it can also lower blood pressure, improve range of motion, and increase endorphins, the body s natural painkillers. Stress Muscle tension and stiffness Discomfort during pregnancy Joint flexibility and range of motion Deeper and easier breathing Circulation of blood Movement of lymph fluids Tension-related headaches Musculoskeletal problems
NATUROPATHY (covered in Connecticut only) Naturopathic medicine is a distinctively natural approach to health and healing that is applied to the whole person, rather than just the specific problem. Naturopaths seek to heal the body from a holistic point of view. The body heals cuts, mends breaks, and controls infections naturally. When these self-repair systems become overwhelmed, they may require assistance. Naturopathic medicine aids the body s natural self-healing mechanisms. For example, to treat high blood pressure, instead of taking medication, a naturopath may suggest diet modification and breathing exercises. Naturopathy may help with: Colds Bronchitis Allergies Heart disease Diabetes Gastrointestinal problems complementary & alternative medicine Oxford Health Plans