Networks change. We verify your specific HealthSun Health Plans 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: HealthSun, HealthSun Medicare, HealthSun MediMax, HealthSun (Elevance). Offered in Florida.
HealthSun Health Plans is a South Florida Medicare Advantage HMO owned by Elevance Health, the parent of Anthem, with its membership concentrated in Miami-Dade, Broward and Palm Beach counties. HealthSun plans are HMO designs built around a network of primary care centers, and they typically offer low or zero premiums with extra benefits for members. Behavioral health is administered by Carelon Behavioral Health, Elevance's behavioral health company, which maintains the psychiatry network and handles authorizations. Most HealthSun plans cover outpatient psychiatry, medication management and psychotherapy for a fixed mental health copay with no deductible. Members must stay in network, and while most plans allow direct access to behavioral health, some HealthSun plan designs require a primary care referral, which we confirm before your first visit.
Telehealth mental health visits from home are typically covered at the same copay as office visits for members located in Florida during the appointment. For Deep TMS, HealthSun must cover what Original Medicare covers and applies Medicare's criteria for severe major depressive disorder after failure of at least two antidepressants and a psychotherapy trial, with prior authorization through Carelon required on all plans and a standard course typically approved when documentation is complete. Spravato is covered as a Part B drug with prior authorization, with documentation of treatment-resistant depression, a concurrent oral antidepressant and REMS-certified administration. Per-session TMS copays and the cost share for Spravato drug and monitoring vary by plan, so our staff verify your specific benefits before treatment is scheduled.
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 HealthSun?
Stedfast Psychiatry accepts HealthSun Medicare Advantage plans at our Palm Beach and Broward county offices where contracted through Carelon Behavioral Health. HealthSun networks differ by plan and county, so confirm your plan by calling the behavioral health number on your card or asking our front desk to verify eligibility before you schedule.
Do I need a referral from my HealthSun primary care doctor?
Most HealthSun plans allow direct access to in-network behavioral health without a referral, but some plan designs require one from your primary care center. Your evidence of coverage states the rule, and we check it when verifying your eligibility. If a referral is needed, your primary care center can usually send it electronically the same day.
What will I pay for a psychiatry visit on HealthSun?
Most HealthSun plans charge a fixed copay for outpatient mental health visits with no deductible, and dual-eligible members typically pay nothing. Telehealth visits usually carry the same copay as office visits. Your evidence of coverage lists the mental health specialty visit amount, and our staff can confirm it before your first appointment.
Will HealthSun cover Deep TMS or Spravato?
Both are covered under Medicare's criteria with prior authorization through Carelon Behavioral Health. TMS requires documented failure of at least two antidepressants and a psychotherapy trial; Spravato requires treatment-resistant depression and a concurrent oral antidepressant. Our team submits the request through Carelon's portal and confirms your per-session or per-dose cost share before scheduling.