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MultiPlan & PHCS Mental Health Coverage

MultiPlan and PHCS are provider networks used by many insurers. Your mental health coverage for inpatient, residential, outpatient, and partial hospitalization programs come from your actual insurance company; here's what you need to know.

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About MultiPlan

MultiPlan (now Claritev) isn't an insurance company—it's a PPO network that insurance companies and employers use to access negotiated provider rates. If your card shows "MultiPlan" or "PHCS," your actual insurer partners with their network, but your benefits, claims, and authorizations are handled by your real insurance company.

If you're seeking mental health or dual diagnosis treatment and your card shows MultiPlan, you'll need to identify your actual insurance company to understand your coverage. This guide explains how MultiPlan works and how to verify your real benefits.

Headquarters McLean, Virginia
Consumers Served 60 Million+
Network 1.4M+ Providers
Founded 1980
Important: Your benefits come from your actual insurer, not MultiPlan
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Mental Health Treatment by Level of Care

Plans that use MultiPlan networks typically cover these levels of care when medically necessary. Your actual insurer determines your specific benefits—click any level to learn more.

Most Intensive
Least Intensive

Inpatient Hospitalization

24/7 hospital care 3–14 days typical

The highest level of psychiatric care, providing round-the-clock medical supervision in a hospital setting. Inpatient hospitalization is reserved for acute psychiatric crises requiring immediate stabilization—severe depression with suicidal ideation, active psychosis, or medical detoxification when co-occurring substance use requires monitored withdrawal management.

About This Level

  • SettingHospital psychiatric unit
  • Duration3–14 days typical
  • Hours24/7 supervision
  • Medical careContinuous monitoring

Typical Coverage

  • Most commercial plans cover when medically necessary
  • Prior authorization required through your insurer
  • MultiPlan network may mean lower out-of-pocket costs
  • Concurrent reviews every 1–3 days typical
Services Typically Included
Room & Board 24/7 Nursing Care Psychiatric Evaluation Crisis Stabilization Individual Therapy Group Therapy Medication Management Medical Detox Discharge Planning

Medical Necessity Criteria

  • Imminent risk of harm to self or others
  • Lower levels of care insufficient for stabilization
  • 24/7 medical monitoring clinically required
  • Criteria determined by your actual insurance company

Residential Treatment

24/7 structured care 30–90 days typical

24/7 care in a home-like, non-hospital environment for those who need intensive support but not hospital-level medical monitoring. Residential treatment is particularly effective for dual diagnosis, where co-occurring mental health and substance use disorders require removing someone from triggering environments to create space for deeper therapeutic work.

About This Level

  • SettingLicensed residential facility
  • Duration30–90 days typical
  • Hours24/7 staffing
  • StructureFull therapeutic immersion

Typical Coverage

  • Coverage varies widely by plan design
  • Prior authorization required through your insurer
  • Concurrent reviews typically every 5–7 days
  • Single case agreements possible for out-of-network
Services Typically Included
Room & Board 24/7 Staff Supervision Psychiatric Care Individual Therapy Group Therapy Family Therapy Medication Management Case Management Discharge Planning

Medical Necessity Criteria

  • PHP or outpatient insufficient for symptom management
  • Risk factors requiring 24/7 structure (not hospital-level)
  • Environment removal necessary for stabilization
  • Documented failed attempts at lower levels of care

Partial Hospitalization Program

5–6 hours/day 2–4 weeks typical

Intensive day treatment providing 5–6 hours of structured programming per day, 5 days per week, while you return home each evening. PHP is the highest level of outpatient care—it works as a step down from residential or inpatient, or as direct entry for those who need intensive support but can maintain safety outside a 24-hour setting.

About This Level

  • SettingOutpatient treatment center
  • Duration2–4 weeks typical
  • Hours5–6 hours/day, 5 days/week
  • EveningsReturn home

Typical Coverage

  • Generally well-covered by commercial plans
  • Prior authorization often required
  • Billed per day (bundled rate)
  • Some plans may have day limits per year
Services Typically Included
Individual Therapy Group Therapy Psychiatric Evaluation Medication Management Family Therapy Psychoeducation Groups Skills-Building Groups Case Management

Medical Necessity Criteria

  • Standard outpatient insufficient for symptom severity
  • Able to maintain safety outside 24/7 setting
  • Functional impairment documented clinically
  • Insurance may review weekly for continued stay

Intensive Outpatient Program

3 hours/day 4–8 weeks typical

Structured treatment for approximately 3 hours per day, 3–5 days per week, with flexible morning, afternoon, or evening sessions. IOP allows you to continue working, attending school, or managing family responsibilities while receiving intensive therapeutic support. This level works as a step down from PHP or residential, or as direct entry for moderate symptoms.

About This Level

  • SettingOutpatient center or virtual
  • Duration4–8 weeks typical
  • Hours3 hours/day, 3–5 days/week
  • SchedulingAM, PM, or evening options

Typical Coverage

  • Well-covered by most commercial plans
  • Many insurers no longer require prior auth for IOP
  • Billed per session
  • Often the most affordable intensive option
Services Typically Included
Individual Therapy Group Therapy Psychiatric Evaluation Medication Management Family Therapy Psychoeducation Groups Skills-Building Groups Case Management

Outpatient Therapy

1–2 sessions/week Ongoing

Traditional therapy sessions 1–2 times per week for ongoing mental health support, maintenance, and long-term recovery. Outpatient therapy is the foundation of sustained wellness—it helps you process experiences, develop coping strategies, and maintain progress made in higher levels of care. Available in-person or via telehealth.

About This Level

  • SettingOffice or telehealth
  • DurationOngoing as needed
  • Sessions1–2 per week, 45–60 min
  • FlexibilitySchedule around your life

Typical Coverage

  • Covered under most behavioral health benefits
  • In-network copays typically $20–$50/session
  • No prior authorization for routine outpatient
  • Some plans limit sessions per year
Services Typically Included
Individual Therapy Psychiatric Services Medication Management Telehealth Sessions Psychological Testing Aftercare Planning

Not sure what your plan covers?

We'll verify your benefits and explain your options—no obligation.

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Who Uses the MultiPlan Network?

MultiPlan doesn't sell insurance directly. Instead, these types of plans contract with MultiPlan to give their members access to negotiated provider rates. Your actual benefits depend entirely on your underlying insurance or benefit plan.

Self-Funded Employer Plans

Most Common
  • Large and mid-size companies that pay claims directly
  • Often have generous out-of-network benefits
  • Card may show employer name + MultiPlan logo
  • HR or benefits administrator handles claims

TPA-Administered Plans

Third-Party Admins
  • Companies like HealthSCOPE, CoreSource, Meritain
  • Manage claims for self-funded employers
  • TPA name appears on your ID card
  • Call TPA for benefit questions, not MultiPlan

Association Health Plans

Group Coverage
  • Trade associations and professional groups
  • Union health and welfare funds
  • Chamber of commerce group plans
  • Association name is your "insurer" for benefits

Regional Insurance Carriers

Smaller Insurers
  • State or regional insurers without national networks
  • Contract with MultiPlan for broader access
  • Insurance company name is on your card
  • Benefits set by the carrier, not MultiPlan

Small Business & Startup Plans

Cost-Effective Access
  • Companies with 2–50 employees
  • Level-funded or partially self-funded arrangements
  • Often bundled with stop-loss coverage
  • Check with employer's HR for exact benefits

Mental Health Conditions Typically Covered

Most commercial health plans that use MultiPlan networks cover treatment for these mental health conditions when medically necessary. Your actual coverage depends on your specific insurance plan—MultiPlan provides network access, but your insurer determines what's covered and at what level.

Mood Disorders

Anxiety Disorders

Trauma & Stress-Related

Personality Disorders

  • Borderline Personality Disorder (BPD)
  • Narcissistic Personality Disorder
  • Avoidant Personality Disorder
  • Dependent Personality Disorder
  • Obsessive-Compulsive Personality Disorder
  • Other Cluster A, B, C Disorders

OCD & Related Disorders

  • Obsessive-Compulsive Disorder (OCD)
  • Body Dysmorphic Disorder
  • Hoarding Disorder
  • Trichotillomania (Hair-Pulling)
  • Excoriation (Skin-Picking)
  • OCD Spectrum Conditions

Other Conditions

  • ADHD (Attention-Deficit/Hyperactivity)
  • Eating Disorders (Anorexia, Bulimia, Binge Eating)
  • Dissociative Disorders
  • Sleep-Wake Disorders
  • Somatic Symptom Disorders
  • Co-Occurring Substance Use Disorders

Your actual insurer determines coverage—not MultiPlan. MultiPlan provides network access and negotiated rates, but coverage decisions, medical necessity criteria, and authorization requirements come from your underlying insurance company or benefit plan. Contact the member services number on your ID card (not the MultiPlan number) to verify what conditions and treatment levels your specific plan covers.

Dual Diagnosis Treatment Coverage

When mental health conditions and substance use disorders occur together—called dual diagnosis or co-occurring disorders—integrated treatment addresses both simultaneously. Most commercial plans using MultiPlan networks cover dual diagnosis care, but your actual insurer determines the specifics.

Supportive dual diagnosis treatment at Redefine Wellness - integrated care for mental health and substance use recovery

What Is Dual Diagnosis?

Dual diagnosis means having both a mental health condition and a substance use disorder at the same time. These conditions often fuel each other: untreated anxiety leads to self-medicating with alcohol, which worsens depression, which increases drinking. Breaking this cycle requires treating both conditions together.

Medical Detox 24/7 medically supervised withdrawal management with psychiatric stabilization for acute crisis
Residential (30–90 days) Most common for dual diagnosis—integrated programming in a structured, immersive environment
PHP / IOP Step-down care or direct entry for those with stable living environments

What to Know About Coverage

Mental Health Parity Act

  • Federal law requires SUD coverage at parity with medical benefits
  • Applies to detox, residential, PHP, IOP, and outpatient levels
  • Plans cannot impose stricter limits on SUD than other conditions

Your Actual Insurer Determines

  • Whether detox and residential are covered benefits
  • Prior authorization requirements and medical necessity criteria
  • In-network vs. out-of-network cost sharing

MultiPlan's Role

  • Provides network access to dual diagnosis treatment facilities
  • Negotiated rates may lower your out-of-pocket costs

Questions to Ask Your Insurance Company

  • Does my plan cover dual diagnosis treatment?
  • Is medical detox covered? What preauthorization is required?
  • Are there separate limits for SUD vs. mental health benefits?

Not sure what your plan covers?

We'll verify your benefits and explain your options—no obligation.

Call Now Verify Online

Getting Treatment Approved

MultiPlan doesn't handle prior authorization—that's done by your actual insurance company. But understanding how the authorization process typically works can help you prepare for treatment.

Who Handles Authorization?

Your actual insurance company (not MultiPlan) reviews and approves treatment requests. The treatment facility typically submits authorization requests on your behalf.

  • Facility gathers clinical documentation and submits to your insurer
  • You provide your insurance card and basic information
  • Our admissions team manages the entire process for you

Find your insurer first: Look at your ID card for a company name besides MultiPlan or PHCS. That's who you'll need to work with for authorization questions.

Typical Authorization Requirements

Level of Care Auth Required? Typical Review
Inpatient Usually Every 1–3 days
Residential Usually Every 5–7 days
PHP Often Weekly
IOP Varies Every 2 weeks
Outpatient Rarely N/A (routine care)

Common Medical Necessity Criteria

  • Diagnosis — Mental health or SUD
  • Severity — Symptoms & impairment level
  • Safety — Risk to self or others
  • Failed lower levels — Why needed

Concurrent Review & Continued Stay

Once treatment begins, most insurers assign a Care Manager who reviews your progress at regular intervals to authorize additional days or sessions:

  • Clinical team provides updates showing continued medical necessity
  • Reviews happen every few days (inpatient) to weekly (PHP/IOP)
  • Extensions approved if you still meet clinical criteria

If continued stay is denied: The facility can request a peer-to-peer review, where your treatment team speaks directly with a physician from your insurance company to advocate for your care.

Appeals Process for Denials

If your insurer denies authorization or continued stay, you have the right to appeal. Most plans allow appeals within 180 days of the denial:

  • Internal appeal — Your insurer reviews the denial
  • External appeal — Independent third-party review available
  • Expedited appeal — For urgent situations, faster decisions

Know your rights: Under the Mental Health Parity Act, insurers cannot apply stricter limits to mental health care than to medical/surgical care.

Help Paying Your Deductible

Deductibles for plans using MultiPlan networks vary widely based on your actual insurer and employer's plan design. If you're facing financial hardship, there are options that may help reduce your out-of-pocket costs.

Compassionate financial assistance consultation at Redefine Wellness - helping you navigate treatment costs

Treatment Facility Assistance

  • Sliding scale fees adjusted to income
  • Payment plans to spread costs over time
  • Charity care for qualifying patients
  • Scholarships at some facilities

Tip: Contact billing or admissions before treatment to discuss options.

Hardship Waiver Requests

  • Providers can waive copays/deductibles for financial need
  • Income documentation typically required
  • Criteria often tied to Federal Poverty Guidelines
  • Evaluated case-by-case per facility

Qualifying events: Job loss, medical expenses, caring for family member.

Questions to Ask

  • Do you offer financial hardship or charity care?
  • Can I set up a payment plan for my deductible?
  • What documentation do I need to apply?
  • Are scholarships or grants available?

Other Resources

  • EAP benefits — check if your employer offers free sessions
  • SAMHSA grants for state treatment programs
  • HSA/FSA funds for pre-tax savings (if on HDHP)
  • Out-of-pocket max — caps your annual costs (check your plan)

Understanding Insurance Terms

Insurance terminology can be confusing. Here's a quick reference guide to help you understand your benefits. Remember: MultiPlan is just the network—your actual insurer sets these terms.

Deductible

The amount you pay out-of-pocket before your insurer starts covering costs. Most plans have separate in-network and out-of-network deductibles. Your actual insurer sets this amount, not MultiPlan.

If your deductible is $1,500, you pay the first $1,500 of covered services before insurance begins paying its share.

Coinsurance

Your percentage share of costs after you've met your deductible. Common splits are 80/20 or 70/30 in-network, and 50/50 or 60/40 out-of-network. Check your plan documents for your specific rates.

With 20% coinsurance, you pay $200 of a $1,000 bill; your insurer pays $800.

Copay

A fixed dollar amount you pay for specific services. Copays are common for outpatient therapy visits but less common for intensive programs like PHP or IOP, which typically use coinsurance instead.

You might pay a $30 copay per therapy session regardless of what your provider charges.

Out-of-Pocket Maximum

The most you'll pay for covered services in a plan year. Once you reach this limit, your insurer pays 100% for the rest of the year. This includes your deductible, coinsurance, and copays, but not premiums.

With a $6,000 max, after paying $6,000 total, your insurer covers everything else that year.

In-Network (MultiPlan)

Providers who participate in the MultiPlan or PHCS network. You typically pay less when using in-network providers because MultiPlan has negotiated rates with them. Your insurer then applies your plan's in-network benefits.

In-network treatment might cost you 20% coinsurance vs. 40-50% out-of-network.

Out-of-Network

Providers without a MultiPlan contract. You'll typically pay more, and may need to pay upfront and submit claims for reimbursement. Some plan types (HMO, EPO) have no out-of-network coverage except emergencies.

Out-of-network may be worth it for specialized care not available in the MultiPlan network.

Allowed Amount

The maximum amount your insurer considers "reasonable" for a service. MultiPlan negotiates these rates with in-network providers. Out-of-network providers can bill you the difference between their charge and the allowed amount.

Provider charges $500, allowed amount is $350. Your coverage is calculated based on $350.

Explanation of Benefits (EOB)

A statement your insurer sends after processing a claim. It shows what was billed, what your insurer paid, and what you owe. You can usually view EOBs in your insurer's member portal. This is not a bill.

Review your EOB to make sure the claim was processed correctly before paying any bills.

Prior Authorization

Approval from your actual insurer required before certain services are covered. MultiPlan does not handle authorization—that goes through your insurance company or their behavioral health partner. Inpatient and residential typically require it.

Treatment facilities submit authorization requests to your insurer, not to MultiPlan.

Medical Necessity

The clinical criteria your insurer uses to determine if a treatment level is appropriate for your condition. Common guidelines include MCG™ Behavioral Health Guidelines or InterQual. Your insurer assesses whether your symptoms meet criteria.

Coverage may be denied if your insurer determines a lower level of care would be sufficient.

Concurrent Review

Ongoing check-ins while you're in treatment. Your insurer reviews your progress at regular intervals to authorize additional days or sessions based on continued medical necessity.

Residential treatment typically has reviews every 5–7 days to authorize continued stay.

Single Case Agreement

A negotiated agreement where your insurer agrees to cover an out-of-network provider at in-network rates. This is sometimes used when specialized care isn't available within the MultiPlan network.

SCAs can reduce out-of-pocket costs when in-network options don't meet your clinical needs.

PPO (Preferred Provider)

The most flexible plan type. See any provider without referrals, in-network or out-of-network, though you pay less in-network. Many PPO plans use MultiPlan for network access. Best for accessing specialized treatment.

Best choice if you want the option to go out-of-network for specialized treatment.

Self-Funded Employer Plan

Your employer pays claims directly instead of buying insurance. Many self-funded plans use MultiPlan for network access and rate negotiations. Benefits are set by your employer, so they can be more flexible than traditional insurance.

Self-funded plans often have better mental health benefits than standard commercial plans.

HMO / EPO

Lower premiums but you must use network providers. No out-of-network coverage except emergencies. HMO typically requires a PCP referral for specialists; EPO usually does not require referrals for behavioral health.

Best if cost is your priority and you're flexible about which providers you see.

HDHP with HSA

Lower premiums with a higher deductible ($1,650+ for individuals in 2025). Paired with a tax-advantaged Health Savings Account. You pay more upfront before insurance coverage kicks in.

HSA funds can pay for therapy, psychiatry, and treatment costs tax-free.

Questions about your benefits?

Our team can verify your coverage and explain exactly what you'll pay.

Verify My Benefits

MultiPlan Contact Information & Resources

Use these resources to find providers in the MultiPlan/PHCS network. For benefit questions, authorization, or claims, contact your actual insurance company.

Remember: MultiPlan is a provider network, not an insurance company. They cannot answer questions about your benefits, authorize treatment, or process claims. Look at your ID card for your actual insurer's member services number.

MultiPlan Network
1-888-342-7427
Provider search assistance
PHCS Network
1-800-922-4362
PHCS provider inquiries
Provider Services
1-800-950-7040
For healthcare providers only
Find a Provider (Claritev Search) Member Resources (Claritev) Healthcare Provider Portal No Surprises Act (CMS)

Tip: Your ID card has two important pieces of information: the MultiPlan/PHCS logo (which tells you the network) and your actual insurer's name and phone number (which is who you contact for benefits, authorization, and claims).

Frequently Asked Questions

Questions about MultiPlan, privacy, dependents, and coverage details.

No. MultiPlan is a network access company, not an insurance company.

If your card shows MultiPlan or PHCS, it means your actual insurer contracts with MultiPlan's provider network for negotiated rates. Your benefits, authorization requirements, and coverage decisions come from your real insurer. Look for another company name on your ID card (like Aetna, BCBS, or a self-funded employer plan).

Look at your insurance ID card for the company name that isn't MultiPlan or PHCS:

  • Check the member services phone number—that's your actual insurer
  • Look at where your premiums are deducted (your pay stub may show the insurer name)
  • Call the member services number and ask: "Who is my actual insurance carrier?"

No. HIPAA protects your mental health treatment information from your employer.

Your employer cannot see what services you receive, what conditions you're treated for, or which providers you visit. Self-funded employer plans have the same HIPAA protections. The only data employers may access is aggregate, de-identified claims data for the company as a whole.

Most plans do. Plans using MultiPlan networks typically cover mental health treatment for eligible dependents:

  • Spouses and domestic partners (if included in your plan)
  • Children up to age 26 under the ACA dependent coverage rule
  • No restrictions on student status, employment, marital status, or living situation

Contact your actual insurer to confirm dependent coverage for your specific plan.

No. The ACA eliminated lifetime and annual limits on mental health benefits and prohibits denying coverage based on pre-existing conditions.

Your insurer cannot deny treatment, charge higher premiums, or impose waiting periods because of prior mental health diagnoses or treatment history.

Coordination of benefits rules determine which plan pays first:

  • Your own employer plan is typically primary over a spouse's plan
  • For children, the "birthday rule" makes the parent whose birthday falls earlier in the calendar year the primary plan
  • The secondary plan may cover remaining costs up to its benefit limits

Inform both insurers and your treatment provider about dual coverage.

Brenna Gonzales, LPC, SEP, CMAT
Clinically Reviewed By
Brenna Gonzales
LPC, SEP, CMAT • Trauma-Focused Therapist • 13+ Years Experience
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