Multiplan or PHCS for Therapy

Private Healthcare Systems (PHCS) is a health insurance company that offers millions of members across the country coverage for medical and behavioral health care. They partner with Multiplan for access to its PPO network. Many therapists are part of the Multiplan network and take PHCS insurance to make mental healthcare more affordable for clients.

Does PHCS cover therapy?

Yes, PHCS provides coverage for therapy services. Members of PHCS health insurance plans have mental health benefits, which vary based on the plan under which they’re enrolled. PHCS is a large health insurance company with a wide range of plan types, therefore the amount of coverage ranges. However, the majority of PHCS plans offer members coverage of therapy costs. Seeing a therapist in-network with Multiplan is the most affordable option, as seeing an out-of-network therapist may cost more.

How do I check if my PHCS plan covers therapy?

To check if your PHCS health insurance plan offers coverage for mental health services like therapy, locate your Summary and Benefits document. This document lists out how much cost is your responsibility based on the service type. Look for the “outpatient mental health services” or “behavioral/mental health outpatient” line — here you’ll find a copayment or coinsurance rate. You’ll find your Summary and Benefits document through your online PHCS portal.

You might also give the PHCS customer service hotline a call to confirm your mental health benefits. You can find this phone number on the back of your insurance card.

How much does therapy cost with my PHCS plan?

While coverage depends on your specific plan, expect to pay around a $20 copayment per visit with a Multiplan provider or a 20% coinsurance per visit with an out-of-network therapist. This rate may be different depending on your plan, so it’s important to determine the exact rates before you start seeing a therapist.

If you’re concerned about paying for therapy, ask your therapist about sliding scale options. If your therapist offers sliding scale payments, you may be eligible to pay a lowered fee per session.

What types of mental health conditions does PHCS cover?

PHCS health insurance covers services for many mental health conditions. To reimburse therapists or clients, PHCS requires that the client receive a diagnosis from their therapist. This diagnosis guides treatment and the insurance coverage.

A few mental health conditions covered by PHCS include:

• Depression
• Anxiety
• Eating disorders
• ADHD
• Substance abuse
• PTSD

What types of therapy does PHCS cover?

PHCS requires that a licensed therapist provide evidence-based, clinically rigorous therapy to be eligible for reimbursement.

These evidence-based therapy modalities include:

• Cognitive Behavioral Therapy (CBT)
• Dialectical Behavioral Therapy (DBT)
• Eye Movement Desensitization and Reprocessing (EMDR)
• Mindfulness practices
• Child-parent psychotherapy
• Acceptance and Commitment Therapy (ACT)

There are many more types of therapies -- and often, therapists blend modalities into their own approaches, all of which are covered by PHCS.

What types of therapy does PHCS NOT cover?

PHCS does not cover life coaching or career counseling — this is because coaching is generally based upon goals rather than a diagnosis. Magellan Health also does not provide coverage for holistic treatment modalities like aromatherapy or massage therapy. It does not cover energy work such as reiki healing.

Does PHCS cover online therapy?

Yes, PHCS covers online therapy services. Many clients prefer to see their therapists online via a secure online platform, as it makes mental health treatment convenient and more accessible. PHCS offers the same coverage and benefits for online therapy and in-person therapy.

Does PHCS cover couples therapy?

The majority of the PHCS health insurance plans do not cover couples therapy. Check with your specific plan to see if seeing a couples therapist will be reimbursable.

If your PHCS health insurance benefits do not cover couples therapy but you’re still interested in working with a couples therapist, there are many ways to make couples therapy more affordable.

Do I need to see my primary doctor before starting therapy?

Because PCHS is a PPO plan — using Multiplan as the PPO provider network — you do not need a referral from your primary care physician before starting your search for a great therapist. This will save you time and it also opens the doors for the beginning of your mental health journey with a therapist who is a perfect match for you.