Networks change. We verify your specific Ambetter plan before your first visit; call with your member ID and we will confirm benefits, copay and any referral or authorization requirements.
Also appears on cards as: Ambetter from Sunshine Health, Ambetter from Absolute Total Care, Centene marketplace.
Ambetter is the Affordable Care Act marketplace brand of Centene, sold in Florida as Ambetter from Sunshine Health and in South Carolina as Ambetter from Absolute Total Care. It is one of the largest marketplace carriers in both states, particularly among members receiving premium subsidies. Ambetter plans are HMO or EPO designs with no out-of-network coverage apart from emergencies, so network confirmation is essential. Referrals are not required for behavioral health. Mental health visits are covered at parity with medical specialist visits; Ambetter's Balanced Care and Everyday Care plans typically set a copay for outpatient mental health, while bronze and some silver plans apply the deductible first. Telehealth psychiatry is covered at parity for members in their home state.
Ambetter follows Centene's clinical policies, which cover transcranial magnetic stimulation for major depressive disorder when you have failed at least two antidepressants from different classes at adequate dose and duration, have had psychotherapy, and have a current severity score. Prior authorization is required and generally approves a standard course of 36 sessions. Spravato is covered with prior authorization for treatment-resistant depression, with a concurrent oral antidepressant and REMS-certified administration required; the drug is often supplied through Centene's specialty pharmacy. Our staff submit both authorizations and explain your deductible exposure before treatment begins.
What we check before your visit
- Whether your plan is in network at the office you chose and for telehealth
- Your copay or coinsurance for an evaluation and for follow-ups
- Whether a primary-care referral is required (common with HMO plans)
- Prior-authorization criteria for Deep TMS and Spravato, if those are being considered
Frequently asked questions
Does Stedfast Psychiatry accept Ambetter?
Stedfast Psychiatry accepts Ambetter from Sunshine Health in Florida and Ambetter from Absolute Total Care in South Carolina at many of our offices, but Ambetter's networks vary by county and by plan. Use Ambetter's provider search for your plan or call member services to confirm, since Ambetter plans do not pay for out-of-network care.
What is the copay for psychiatry on Ambetter?
Many Ambetter silver and gold plans charge a flat copay for outpatient mental health visits, often $30 to $60, from the first visit. Bronze plans and some silver designs apply the deductible first, then coinsurance. Your summary of benefits lists the mental health outpatient line, and our staff can verify your cost before your appointment.
Does Ambetter cover telehealth psychiatry?
Yes. Ambetter covers video visits with in-network psychiatric providers at the same cost share as office visits for members located in Florida or South Carolina during the appointment. Ambetter also offers its own telehealth vendor for urgent needs, which is separate from ongoing care with your Stedfast provider.
Will Ambetter approve TMS?
Ambetter covers TMS for major depressive disorder with prior authorization when you have documented failure of at least two antidepressants, a psychotherapy trial and a current severity score. Our Palm Beach Gardens team submits the request to Ambetter's utilization management department. Deductibles may apply per session on some plans, so request an estimate first.
Does Ambetter cover Spravato?
Ambetter covers Spravato for treatment-resistant depression with prior authorization. You must be taking an oral antidepressant and receive treatment at a REMS-certified clinic. The drug is usually supplied through Centene's specialty pharmacy, and your cost share depends on your plan's deductible and coinsurance. We handle the authorization and coordinate delivery.