Networks change. We verify your specific Simply Healthcare 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: Simply Healthcare Plans, Simply Medicaid, Simply Healthcare Medicare, Simply (Elevance). Offered in Florida.
Simply Healthcare Plans is a Florida insurer owned by Elevance Health, the parent of Anthem, and it operates Medicaid managed care plans under the Statewide Medicaid Managed Care program along with Medicare Advantage plans, including dual-eligible special needs plans for people with both Medicare and Medicaid. Simply serves Medicaid members across most of Florida, including Palm Beach, Broward, Martin, St. Lucie, Brevard and Duval counties where Stedfast Psychiatry has offices. Behavioral health benefits are administered through Carelon Behavioral Health, the Elevance behavioral health company. Medicaid members pay nothing for outpatient psychiatry, medication management and therapy, and no referral is needed. Medicare Advantage members pay a fixed mental health copay. Telehealth psychiatry is covered at parity for members in Florida.
Simply follows Carelon's clinical criteria and Florida Medicaid coverage rules for interventional treatments. Transcranial magnetic stimulation requires prior authorization with documentation of major depressive disorder, failure of at least two antidepressants, a psychotherapy trial and a current severity score; Medicare Advantage members are reviewed under Medicare's criteria and adult Medicaid coverage is limited. Spravato requires prior authorization with treatment-resistant depression, a concurrent oral antidepressant and REMS-certified administration. Stedfast Psychiatry staff submit authorizations through Carelon's portal and verify your product 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 Simply Healthcare?
Stedfast Psychiatry accepts Simply Healthcare Medicaid and Medicare Advantage plans at our Florida offices where contracted. Because Simply uses Carelon Behavioral Health for mental health, our providers must be in Carelon's network for your plan. Confirm with Simply member services or ask our front desk to verify your eligibility before scheduling.
What does a psychiatry visit cost on Simply Healthcare?
Medicaid members pay $0 for covered outpatient mental health services. Simply Medicare Advantage members pay a fixed copay for mental health visits, often $0 to $40 depending on the plan, and dual-eligible special needs plan members typically pay nothing. Your plan's summary of benefits lists the amount, and we can confirm it in advance.
Is telehealth covered with Simply Healthcare?
Yes. Simply covers video psychiatry visits at the same level as office visits for members physically located in Florida during the appointment, with no copay for Medicaid members. Telehealth works well for evaluations and follow-ups, including visits for children with a parent present. TMS and Spravato require in-person visits.
Does Simply Healthcare cover Deep TMS?
Simply requires prior authorization for TMS through Carelon Behavioral Health. Medicare Advantage members are reviewed under Medicare's criteria for major depressive disorder after failure of two antidepressants and psychotherapy. Adult Medicaid coverage of TMS is limited in Florida. Our Palm Beach Gardens TMS team submits documentation and tells you the likely outcome before you commit.
Will Simply Healthcare cover Spravato?
Simply covers Spravato with prior authorization for treatment-resistant depression when you are taking an oral antidepressant and receive treatment at a REMS-certified clinic. Medicaid members pay nothing for approved treatment, and Medicare Advantage members pay their plan's cost share. We handle the authorization and offer Spravato at three Palm Beach County offices.