Networks change. We verify your specific Oscar 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: Oscar Health, Oscar. Offered in Florida.
Oscar Health sells individual and family plans on the Affordable Care Act marketplace in Florida, where it is one of the larger marketplace carriers, and in a limited number of other states. All Oscar plans are EPO or HMO designs, which means there is no out-of-network coverage except for emergencies, so it is important to confirm that your Stedfast Psychiatry provider is in Oscar's network for your plan tier. Oscar does not require referrals for behavioral health, and mental health visits are covered under the same cost-sharing rules as medical specialist visits, as the ACA requires. Depending on your metal tier, a psychiatry visit may be a copay of $30 to $75 or coinsurance after the deductible. Oscar covers telehealth psychiatry at parity and promotes virtual care through its app.
For Deep TMS, Oscar's clinical guidelines cover transcranial magnetic stimulation for major depressive disorder when you have failed at least two antidepressant trials and have documented severity, with prior authorization required and an initial course approved. Spravato requires prior authorization with documentation of treatment-resistant depression, a concurrent oral antidepressant and treatment at a REMS-certified site, and it may be routed through Oscar's pharmacy benefit. Because many Oscar members hold bronze or silver plans with sizable deductibles, our staff provide a cost estimate before interventional treatment starts.
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
Is Stedfast Psychiatry in network with Oscar?
Stedfast Psychiatry accepts Oscar marketplace plans at our Florida offices, but Oscar networks are narrow and vary by county and plan. Check Oscar's provider search for your specific plan or call the number on your card. Because Oscar plans have no out-of-network benefit, confirming before your first visit matters more than with a PPO.
What will a psychiatry visit cost on an Oscar plan?
It depends on your metal tier. Gold and some silver plans charge a flat specialist copay, often $30 to $75. Bronze and high-deductible silver plans charge the contracted rate until you meet the deductible, then coinsurance. Your plan's summary of benefits lists outpatient mental health cost sharing, and our staff can verify it in advance.
Does Oscar cover telehealth visits with a psychiatrist?
Yes. Oscar covers video psychiatry visits with in-network providers at the same benefit level as office visits for members located in Florida during the appointment. Oscar also offers its own virtual urgent care, which is separate from ongoing psychiatric care with Stedfast providers.
Will Oscar cover Deep TMS?
Oscar covers TMS for major depressive disorder when medical necessity criteria are met, including failure of at least two antidepressants and a current severity score. Prior authorization is required. Our Palm Beach Gardens TMS team submits the request. Deductibles on bronze and silver plans can apply to each session, so ask for an estimate first.
Does Oscar cover Spravato?
Oscar covers Spravato with prior authorization for treatment-resistant depression when you are taking an oral antidepressant and receive it at a certified clinic. The drug may be supplied through Oscar's specialty pharmacy. Deductibles and coinsurance can apply to both the drug and the monitoring visit, so we provide a cost estimate before your first induction session.