Citi Benefits Handbook
Applied Behavior Analysis
Through your Oxford Health Plan, you can access a licensed developmental specialist who understands the complexities of Autism Spectrum Disorder and acts as a helping hand for the family for the entire course of treatment. Autism specialists:
- Provide individualized educational materials, resources and personal guidance to help navigate a maze of choices
- Help obtain a comprehensive evaluation (if needed) and ensure care encompasses the whole person. Trained in intensive behavioral treatments, they are a resource to assist selection of the right providers. They help providers create an intensive behavioral treatment plan that addresses individual needs.
- Help coordinate an array of medical and community resources and assist with periodic treatment plan updates to ensure that the right care leads to the best outcome
- Provide direction with regard to claims
- Help when the family needs answers to questions, additional assistance or simple human support
If you or a covered dependent has cancer, Oxford's Cancer Nurse Advocates can provide information about treatment, answer your questions, help you make informed decisions, and guide you to a provider in your local community or within your provider's network. Information is also available for Cancer Centers of Excellence network facilities, which are nationally respected organizations chosen because of their high-quality care and results.
To seek support or to find more information about the Cancer Support Program and the Cancer Centers of Excellence network, please call 1 (866) 936-6002 between 8 a.m. and 8 p.m. ET, Monday through Friday. For hearing-impaired assistance, please call the National TTY Relay Center at 1 (800) 855-2880. The Cancer Support program is optional, and you have no obligation to use the service or receive treatment at a Cancer Centers of Excellence network facility.
The Transitional Case Management (TCM) Program
The TCM program can help support you as you transition from an inpatient setting to a home setting. In an effort to prevent avoidable readmissions, TCM consists of discharge follow-up and case management. Discharge follow-up calls are made to assist you with:
- Treatment plan adherence
- Medication adherence
- Physician follow-up
- Disease process education
- Caregiver availability information
- Home care evaluation and resources
- Referrals to other CM/DM programs (i.e., Active Care EngagementSM, Cancer Support and Transplant)
- For Medicare members, case stabilization is also available (i.e., home care, resources)
Medicare members; covered individuals who are participating in another Oxford clinical program, such as our Active Care EngagementSM, Rare Chronic Care, Cancer Support or Transplant program; and covered individuals who have secondary coverage through an Oxford plan are not eligible for TCM.
Neonatal Resource Services (NRS) Program
Oxford's Neonatal Resource Services (NRS) program has a dedicated team of specialized, experienced Neonatal Intensive Care Unit (NICU) nurse case managers and full-time medical directors who are well equipped to plan care for fragile neonates. Specially trained neonatal nurse case managers manage the NICU stay and provide support to families of newborns who require critical care. On-staff medical directors with a background in neonatology and pediatrics oversee NICU admissions and provide physician-to-physician consultations as appropriate.
The Complex Case Management (CCM) Program
The CCM program connects you with specialized nurses as well as other resources if you are managing a complex condition. A Complex Case Management Nurse will:
- Provide one-on-one health care information, guidance and support
- Help coordinate care with physicians and health care professionals
- Provide support in understanding and following a physician's treatment plan
- Help provide education to support self-care skills
- Provide guidance in obtaining the right equipment and self-care supplies
- Provide support to assure medication compliance
More than 23 high-risk conditions are supported through the CCM program, with referrals to cancer support, transplant and neonatology resource services, programs and specialists in these complex areas. If you are managing a complex condition, the CCM program will reach out to you to assist you with your care and treatment. Medicare members; covered individuals who are participating in another Oxford clinical program, such as our Active Care Engagement, Rare Chronic Care, Cancer Support or Transplant program; and covered individuals who have secondary coverage through an Oxford plan are not eligible for CCM.
Managed Infertility Program (MIP)
MIP complements the treatment plan created by you and your doctor to help you make informed decisions regarding infertility care. MIP nurse case managers and the reproductive endocrinologist can help you find quality infertility care, review benefits plans and applicable state mandates, discuss treatment options, and review any proposed treatment plans. Specialized nurses can review outcomes with you as well as discuss next steps.
For more information, call the number on the back of your ID card.