Networks change. We verify your specific Prominence Health Plan 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: Prominence Health Plan of Florida, Prominence, Prominence Medicare Advantage. Offered in Florida.
Prominence Health Plan is a regional insurer owned by Universal Health Services, one of the largest hospital companies in the country, with Florida operations centered in Palm Beach, Broward and Miami-Dade counties and additional markets in Nevada and Texas. In Florida, Prominence offers employer-group plans and Medicare Advantage HMO and PPO plans, and its network is built around hospitals and physician groups that Universal Health Services owns or partners with. Most Prominence plans cover outpatient psychiatry and medication management for a specialist copay or coinsurance on commercial plans and a fixed mental health copay on Medicare Advantage plans. HMO members are expected to stay in network, but most plans do not require a primary care referral for behavioral health visits.
Telehealth psychiatry is typically covered at parity with office visits for members located in Florida during the appointment. For Deep TMS, Prominence requires prior authorization and reviews requests for medical necessity, typically asking for a diagnosis of major depressive disorder, documented failure of at least two antidepressant trials at adequate dose and duration, and a current severity score; Medicare Advantage members are reviewed under criteria aligned with Medicare's coverage rules. Spravato typically requires prior authorization with documentation of treatment-resistant depression, a concurrent oral antidepressant and administration at a REMS-certified site, billed under the medical benefit. Because Prominence is a smaller plan with a local utilization management team, decisions are usually reached within a few business days. Our Palm Beach County offices submit requests directly.
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 Prominence Health Plan?
Stedfast Psychiatry accepts Prominence Health Plan commercial and Medicare Advantage plans at our Florida offices where contracted, with the closest overlap in Palm Beach and Broward counties. Prominence networks differ between HMO and PPO products, so confirm your plan by calling member services or asking our front desk to verify eligibility before scheduling.
What will I pay for a psychiatry visit on Prominence?
Commercial members typically pay a specialist copay or coinsurance after the deductible, depending on plan design. Medicare Advantage members typically pay a fixed copay for outpatient mental health visits with no deductible. Your summary of benefits lists the outpatient behavioral health cost share, and our staff can confirm the amount before your first appointment.
Does Prominence cover telehealth with a psychiatrist?
Yes. Prominence covers video psychiatry visits with in-network providers at the same cost share as office visits for members physically located in Florida during the appointment. Telehealth works well for evaluations and medication follow-ups. Deep TMS and Spravato are delivered in person at Palm Beach Gardens and our other Palm Beach County offices.
Will Prominence authorize Deep TMS or Spravato?
Both treatments require prior authorization. Prominence reviews TMS for major depressive disorder after documented failure of at least two antidepressants and a current severity score, and Spravato for treatment-resistant depression with a concurrent oral antidepressant and REMS-certified administration. Our staff submit the records and typically hear back within a few business days.