Multiplan or PHCS | Mental Health Coverage | Zencare — Zencare
Does PHCS Cover Therapy?
PHCS, or Private Healthcare Systems, is a health insurance company that offers nationwide coverage for medical and behavioral health care. They have partnered with Multiplan to access their PPO network. Many therapists are part of the Multiplan network and accept PHCS insurance, making mental health care more affordable for clients.
How Can I Check if My PHCS Plan Covers Therapy?
To determine if your PHCS health insurance plan covers mental health services like therapy, you can refer to your summary and benefits document. This document provides information about your responsibility based on the type of service. Look for lines such as “outpatient mental health services” or “mental/behavioral health outpatient.” Here, you will find your copay or coinsurance rate. You can access your summary and benefits document through your online PHCS portal.
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Alternatively, you can call the PHCS customer service hotline, which you can find on the back of your insurance card, to confirm your mental health benefits.
How Much Does Therapy Cost with My PHCS Plan?
While the exact cost depends on your specific plan, you can expect to pay around $20 as a copay per visit with a Multiplan provider or 20% coinsurance per visit with an out-of-network therapist. It’s crucial to determine the exact fees before starting therapy as they may vary depending on your plan.
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If you have concerns about affording therapy, consider asking your therapist about sliding scale options. Some therapists offer reduced fees per session based on income.
What Mental Health Conditions Does PHCS Cover?
PHCS health insurance covers services for a wide range of mental health conditions. To receive reimbursement, PHCS requires clients to receive a diagnosis from their therapist. This diagnosis guides treatment and insurance coverage.
Some typical mental health conditions covered by PHCS include depression, anxiety, eating disorders, ADHD, substance abuse, and PTSD.
What Types of Therapy Does PHCS Cover?
PHCS covers evidence-based therapy modalities provided by licensed therapists. These therapy modalities include Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Eye Movement Desensitization and Reprocessing (EMDR), mindfulness practices, parent-child psychotherapy, and Acceptance and Commitment Therapy (ACT). Therapists often combine modalities in their approaches, and all of them are covered by PHCS.
What Types of Therapy Are Not Covered by PHCS?
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PHCS does not cover life coaching or career counseling because these services are generally goal-based rather than diagnosis-based. Additionally, holistic treatment modalities such as aromatherapy or massage therapy are not covered. Energy work like reiki healing is also not covered.
Does PHCS Cover Online Therapy?
Yes, PHCS covers online therapy services. Many clients prefer the convenience and accessibility of seeing their therapists through a secure online platform. PHCS offers the same coverage and benefits for online therapy as they do for in-person therapy.
Does PHCS Cover Couples Therapy?
Most PHCS health plans do not cover couples therapy. However, you should check with your specific plan to see if seeing a couples therapist is reimbursable.
If your PHCS health insurance benefits do not cover couples therapy but you are still interested in working with a couples therapist, there are alternative ways to make it more affordable.
Do I Need to See My GP before Starting Therapy?
As PHCS is a PPO plan that uses Multiplan as the PPO provider network, you do not need a referral from your primary care doctor before beginning your search for a therapist. This saves you time and allows you to find the perfect therapist to start your mental health journey.
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