Networks change. We verify your specific MultiPlan and PHCS 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: MultiPlan, MultiPlan PPO, PHCS, Private Healthcare Systems, PHCS Network, MultiPlan Network.
MultiPlan is not an insurance company. It is a national network that leases its contracted provider rates to insurers, third-party administrators, union trusts and self-funded employer plans, and PHCS, short for Private Healthcare Systems, is the primary network brand MultiPlan licenses. If your card shows the MultiPlan or PHCS logo, usually in a corner, the plan named on the front of the card pays your claims and sets your benefits, and MultiPlan's contract is what makes a provider in network for you. These arrangements are common on cards from smaller insurers, health-sharing style plans, union health funds and employers that administer their own benefits. Most plans that use MultiPlan or PHCS cover outpatient psychiatry and medication management for a specialist copay or coinsurance, and referrals are rarely required.
Telehealth psychiatry is typically covered at parity with office visits under the plan named on your card, provided you are located in Florida or South Carolina during the appointment, although a few plans limit video care to their own vendor. Prior authorization for Deep TMS and Spravato is handled by the plan administrator or its utilization review vendor, not by MultiPlan, and the criteria vary with the plan. Most apply standard medical necessity requirements: major depressive disorder with failure of at least two antidepressants and a current severity score for TMS, and treatment-resistant depression with a concurrent oral antidepressant and REMS-certified administration for Spravato. Some self-funded plans exclude these treatments entirely, so our staff read your plan's benefit summary before any request is submitted.
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
My card has a MultiPlan or PHCS logo. Does Stedfast Psychiatry accept it?
Stedfast Psychiatry participates in the MultiPlan and PHCS networks at our Florida and South Carolina offices where contracted, which typically makes us in network for plans that lease those networks. The payer on the front of your card determines your benefits. Give our front desk your full card details and we will confirm eligibility and cost share before your first visit.
Who do I call to verify my benefits, MultiPlan or my insurance company?
Call the member services number on your card, which reaches the plan administrator that pays your claims. MultiPlan only supplies the network contract and does not hold your benefit information. Our staff can make that call for you and confirm your deductible, copay or coinsurance for outpatient psychiatry before you come in.
Is telehealth covered on a plan that uses MultiPlan or PHCS?
Most plans that use these networks cover video psychiatry visits at the same cost share as office visits for members located in Florida or South Carolina during the appointment. A few self-funded plans direct telehealth to a specific vendor. We confirm your plan's rule in advance. Evaluations and medication follow-ups are both well suited to video.
How is Deep TMS or Spravato authorized on a MultiPlan or PHCS plan?
The plan administrator named on your card, or its utilization review vendor, handles prior authorization under its own medical policy. Most require documentation of treatment-resistant depression, prior medication trials and current symptom scores. Some self-funded plans exclude these treatments, so we check your benefit summary first and tell you what to expect before submitting a request.