MultiPlan

Learn how MultiPlan networks support mental health care access. Understand coverage verification, provider networks, and authorization processes for behavioral health services.

What Mental Health Services Are Typically Covered Under MultiPlan Networks?

Since MultiPlan works with numerous insurance carriers and health plans, coverage for mental health services depends on your specific insurance plan rather than MultiPlan itself. However, many plans that utilize the MultiPlan network offer coverage for a range of mental health services.

Common Mental Health Services Accessible Through MultiPlan Networks

Mental health coverage through MultiPlan's network typically encompasses outpatient therapy and counseling sessions with licensed professionals, allowing for personalized care through individual therapy, group therapy, or family therapy formats. For those requiring medication management, psychiatric services are generally accessible, providing specialized medical care for mental health conditions.

When more intensive support is needed, many plans include coverage for structured programs like Intensive Outpatient Programs (IOPs) and Partial Hospitalization Programs (PHPs). For severe cases requiring round-the-clock supervision, inpatient or residential treatment at specialized mental health facilities is often covered. Additionally, telehealth mental health services have become increasingly available, providing convenient access to virtual therapy and psychiatric appointments.

Plans utilizing MultiPlan networks commonly cover treatment for various mental health conditions, including:

Evidence-Based Treatment Approaches

Most insurance plans that utilize MultiPlan networks cover evidence-based therapeutic approaches that have demonstrated effectiveness through research and clinical practice. These typically include Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), psychodynamic therapy, mindfulness-based interventions, family therapy, and group therapy, ensuring that care can be tailored to individual needs and preferences.

How MultiPlan Works with Insurance Plans

Unlike traditional insurance companies, MultiPlan does not directly provide health insurance coverage. Instead, it creates and maintains networks of healthcare providers and negotiates discounted rates that are then utilized by various insurance companies and health plans. Your employer or individual insurance plan contracts with MultiPlan to access their provider network, and healthcare providers join the MultiPlan network, agreeing to accept negotiated rates. When you receive services from a MultiPlan network provider, the negotiated rates apply, and your insurance plan determines your specific coverage benefits and pays claims according to your policy.

This structure means that while MultiPlan facilitates access to discounted services, your actual mental health coverage benefits are determined by your specific insurance plan, not by MultiPlan directly.

Insurance Verification and Payment Process

Understanding how to verify your coverage and navigate the payment process is essential for accessing mental health care without unexpected financial burdens.

How to Verify Your Mental Health Coverage with MultiPlan

To verify whether your mental health provider participates in the MultiPlan network and what your coverage includes, start by checking your insurance card for the MultiPlan or PHCS logo, which indicates access to their network. Contact your insurance company using the number on your card to confirm your specific mental health benefits. You can also use MultiPlan's provider search tool on their website to find in-network providers. When verifying with your treatment provider, ask if they participate in the MultiPlan network, and many mental health facilities can verify your benefits and MultiPlan network status.

When verifying your coverage, be prepared to provide your member ID number, insurance plan details, the name of the provider you wish to see, and the types of services you're seeking.

Understanding Your Mental Health Benefits

Important aspects of your coverage to understand include in-network vs. out-of-network coverage (using MultiPlan network providers typically results in lower out-of-pocket costs), deductibles (the amount you must pay before your insurance begins covering services), copayments and coinsurance (your portion of the cost for each service), annual limits (maximum number of sessions or days of treatment covered per year), and coverage exclusions (specific services that may not be covered by your plan).

Authorization Requirements and Approval Process

Many insurance plans require prior authorization for certain mental health services, especially intensive treatments. The authorization process helps ensure that the services are medically necessary and appropriate for your condition.

When accessing mental health care through a plan that utilizes MultiPlan, the authorization process typically begins with your provider submitting clinical information to your insurance company. Your insurance company then evaluates if the requested service meets their criteria and approves, modifies, or denies the service request. Both you and your provider receive the determination.

It's important to note that MultiPlan itself does not handle the authorization process—this is managed by your specific insurance plan. However, providers in the MultiPlan network are familiar with working with various insurance plans and can often help navigate this process.

For successful authorization, work with providers experienced in dealing with your specific insurance plan, ensure your provider submits comprehensive clinical documentation, understand timeframes for authorization decisions, know your appeal rights if a service is denied, and stay in communication with both your provider and insurance company throughout the process.

Common Coverage Limitations and Out-of-Pocket Costs

Insurance plans that utilize MultiPlan networks may have various limitations on mental health coverage, including session limits (some plans cap the number of therapy sessions covered per year), level of care restrictions (criteria for coverage of intensive services may be strict), specific diagnosis requirements (some treatments may only be covered for certain diagnoses), and provider type restrictions (coverage might vary based on provider credentials).

Your financial responsibility typically includes several components: your deductible (the amount you must pay before your insurance coverage begins), copayments (fixed amounts paid per service, such as $25 for each therapy session), coinsurance (a percentage of the allowed charges, commonly 20%, that you pay after meeting your deductible), and an out-of-pocket maximum (which caps the total amount you'll pay in a year before your insurance covers 100% of additional costs).

What to Expect During the Insurance Approval Process

The journey from seeking help to beginning treatment involves several important steps. The initial assessment and treatment planning process includes screening (initial evaluation of your mental health needs), diagnosis (identification of specific mental health conditions), treatment recommendation (determining appropriate level of care and type of care), insurance verification (confirming what your insurance plan will cover), and prior authorization (obtaining necessary approvals when required).

During treatment, be prepared for concurrent reviews (for ongoing or intensive services, your insurance may periodically review your progress to ensure continued coverage), documentation requirements (your provider must maintain clinical records that support the medical necessity of your care), and potential treatment modifications (coverage decisions may influence adjustments to your treatment plan).

Benefits of Choosing a Facility that Accepts MultiPlan

Selecting a mental health provider that participates in the MultiPlan network offers several advantages, including lower out-of-pocket costs (network providers have agreed to accept negotiated rates), streamlined billing (providers handle claims submission directly with your insurance company), broader provider options (the extensive MultiPlan network gives you access to a wide range of mental health professionals), and quality assurance (MultiPlan applies credentialing criteria when selecting providers for their network).

How MultiPlan Differs from Other Insurance Options

Unlike traditional health insurance companies that provide direct coverage, MultiPlan works as a network manager and cost containment solution. MultiPlan does not issue health insurance policies or pay claims directly, your specific benefits are determined by your insurance plan, and MultiPlan provides access to its network of providers who have agreed to discounted rates.

MultiPlan's unique network structure often serves as a complementary or "wrap" network, extending their primary provider network. As a PPO network, MultiPlan typically allows you to see providers outside the network (though with higher out-of-pocket costs), and its extensive nationwide network increases your chances of finding a suitable mental health provider.

How to Determine if Your Specific Plan Covers Needed Treatment

To verify what your specific plan covers for mental health treatment, gather your insurance information, call your insurance company directly using the member services number on your card, use MultiPlan's online provider directory to confirm if your preferred mental health provider participates in their network, work directly with your chosen treatment facility for personalized assistance, and keep detailed records of all verification efforts.

When contacting your insurance company about your mental health coverage, be sure to ask:

What mental health services are specifically covered under your plan
Whether there are any diagnosis exclusions that might limit your access to care
What your deductible is for mental health services
What your copayment or coinsurance obligations are
If there's a limit to the number of sessions covered annually
Which providers are in-network in your area
What the prior authorization process entails

Finding the Right Care: Your Next Steps

When you're ready to find mental health care covered by a plan that utilizes the MultiPlan network, begin by thoroughly verifying your specific benefits by contacting your insurance company directly. Search for in-network providers through MultiPlan's provider directory or by contacting your insurance company's member services. Schedule initial consultations with potential providers, and before your first appointment, prepare by gathering essential information including your insurance card, medical history, and a list of questions about the treatment process.

Finally, commit to following through with your recommended care plan, as consistent engagement with treatment is strongly associated with better mental health outcomes.

Find Mental Health Facilities That Accept MultiPlan Today

Taking the step to seek mental health treatment is a courageous decision. You don't have to navigate this journey alone. Our directory features quality mental health facilities that work with insurance plans utilizing the MultiPlan network, making it easier to find the right care for your specific needs.

Ready to find treatment? Browse our directory of mental health facilities that accept plans using the MultiPlan network in your area. Don't let insurance confusion delay your path to better mental health. Reach out today to find providers who can work with your insurance plan and help you start your healing journey.

References

[1] MultiPlan. "Members MultiPlan Members." https://www.multiplan.us/members/

[2] MultiPlan. "Provider Search." https://providersearch.multiplan.com/

[3] MultiPlan. "Healthcare Provider FAQs." https://www.claritev.com/healthcare-providers/healthcare-provider-faqs/