Insurance

Understanding AvMed Therapy Coverage

Navigating your health insurance coverage can be confusing, especially when it comes to mental health coverage. In this article, we’ll explain what mental health services are covered by the insurance provider AvMed, how to check your benefits, and where to find an in-network therapist. What Is AvMed Insurance? AvMed is an insurance provider offering comprehensive […]

derek lee grow therapy By Derek Lee, VP of Insurance Operations

Updated on Jan 12, 2024

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Navigating your health insurance coverage can be confusing, especially when it comes to mental health coverage.

In this article, we’ll explain what mental health services are covered by the insurance provider AvMed, how to check your benefits, and where to find an in-network therapist.

What Is AvMed Insurance?

AvMed is an insurance provider offering comprehensive coverage across the state of Florida. It’s owned by one of the largest, most prominent not-for-profit health care delivery systems across the United States known as Sentara Healthcare.

As one of Florida’s longest-standing not-for-profit health plans originally created in 1969, AvMed spans the coast serving numerous counties including Palm Beach, Miami-Dade, and Broward. 

Created around the mission “to provide Floridians with healthcare options that prioritize their physical, mental, and emotional well-being,” AvMed strives to enhance awareness and accessibility of mental health services for its members. 

AvMed Insurance provides an array of health plans, spanning from individual and family plans, subsidy-eligible and Medicare plans, employer group plans, and beyond. With every plan offering a range of prices that scales to the level of health benefits you require, AvMed makes it possible to get the perfect coverage to fit your unique lifestyle and needs. 

How AvMed Differs from Other Insurance Providers

Florida-Focused Provider

Having a primary focus on the eastern coastal region, AvMed Insurance is deeply rooted within Florida. Unlike most providers, AvMed’s localized approach allows them to cater to the unique healthcare needs and challenges faced in this state. 

Comprehensive and Reliable Mental Health Coverage

AvMed is a proactive company advocating for the mental health of Floridians. Their comprehensive benefits include therapeutic and counseling services to support the emotional and psychological well-being of its members. 

Tailored Health Plans

AvMed offers a range of tailored health plans and benefits suitable for the needs of individuals and families across the state. Their coverage options, such as HMO and PPO plans, are designed to encompass diverse preferences and requirements. 

Abundant Provider Network

AvMed Insurance maintains a vast network of providers to ensure their members have access to quality care.  

Member-Focused and Cost-Effective Approach

AvMed prioritizes its member’s needs, striving to create a personalized experience by offering resources, support, and first-class customer services. 

As a managed care company, AvMed focuses on cost-effective and efficient healthcare services while also maintaining and emphasizing the quality of care for its members. Their company establishes a vast network of healthcare providers allowing for negotiated, cost-effective rates. 

Many of these professionals require referrals for specialized treatment, such as a psychiatrist consultation. This helps ensure you are receiving the right services for your needs, preventing any unnecessary costs. 

Mental Health Coverage with AvMed

According to the National Alliance on Mental Illness (NAMI), nearly 40.8% of adults in Florida reported symptoms of anxiety or depression in 2021. Over half of these individuals were unable to receive counseling or therapy for their symptoms.

AvMed therapy coverage is created to support mental health for all Florida members. Some key aspects of their mental health coverage include:

From a holistic perspective, AvMed’s dedicated coverage helps address many of the key facets of mental health – from providing access to quality care to prevention strategies and early education.

AvMed is committed to simplifying the financial aspects of healthcare, ensuring its members are equipped with the knowledge and tools to make more informed decisions. 

Here are three things you need to better understand your AvMed insurance: 

Co-Pays

AvMed typically require co-payments, the amount you pay at the time of service, which can vary depending on the specific plan and type of service, treatment, or medication required. For example, a plan may have different co-pays for primary care visits with your doctor compared to specialist visits with a mental health professional. 

To find out the exact copayment amount for your AvMed plan, refer to your insurance policy documents, member handbook, or contact AvMed customer service. 

Coinsurance 

Coinsurance is the set percentage of healthcare costs that you pay for after you’ve paid your deductible. AvMed offers coinsurance to its members, allowing for a certain percentage of their treatment to be covered. 

Deductibles 

AvMed offers health plans with a range of deductible amounts. Lower deductibles are often associated with higher monthly premiums and vice versa. Once the deductible is met, AvMed can begin covering a portion of the treatment costs. As described in AvMed’s Summary of Benefits and Coverage, the deductible is only applicable to members using in-network providers.

For more affordable plans, AvMed offers Minimum Essential Coverage, which refers to a type of health insurance that is available through individual market policies, Medicare, Medicaid, or certain other coverage. 

In-Network vs. Out-of-Network

Opting for in-network providers, meaning that you choose healthcare professionals or facilities that have a contract with AvMed, ensures you’ll receive covered services at a negotiated, discounted rate. Not only does this make working with in-network providers more cost-effective, but it also helps streamline the billing process to simplify your journey. 

For those individuals or families requiring mental health, behavioral therapy, or substance abuse services, Avmed offers plans with both coinsurance and copay for a range of inpatient and outpatient services. 

On the other hand, choosing an out-of-network provider can provide greater flexibility. However, it often comes with a higher price tag. Since out-of-network providers are not directly contracted by AvMed, the prices for services are less predictable, creating higher out-of-pocket costs for members.  

To find an in-network mental health provider, you can visit the Grow Therapy marketplace. We make it simple to find a therapist in your area who accepts AvMed. Simply fill out the search fields, choose your therapist, and book directly through their profile. You can even get an estimate for your session cost before you book with our cost estimator tool so there are no surprises when it’s time to pay for your appointment.

Get a therapy cost estimate

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A Simple Guide to AvMed Enrollment

If you don’t currently have insurance and would like to sign up for AvMed, you can do so with the following steps:

Step 1: Research and Explore AvMed Plans 

AvMed recognizes that everyone’s needs and preferences for care differ. That’s why there is a range of plans available with varying insurance coverage and costs. 

Visit the AvMed website to review their list of health plans or contact customer service for support. 

Step 2: Determine Your Eligibility

Reviewing your eligibility is key to ensuring that you can receive the coverage you need. Eligibility may vary depending on certain requirements such as age, location of residency, and employment status. 

Step 3: Select a Plan

Choose an AvMed plan that suits your needs and budget. Now is the time to consider the cost of plans, taking into account factors such as deductibles, copayments, monthly premiums, and coverage specific to the therapeutic service you choose. 

Keep in mind that certain plans may require prior authorization for therapy services, coverage limits for the number of sessions covered in a year, or referral requirements from a primary care provider. It’s also important to note that some therapeutic interventions may be restricted.  

Step 4: Complete and Submit Your Application 

Fill out the AvMed enrollment application for your plan and make sure to provide accurate information for this form. Applications often require personal details, contact information, and documentation (i.e. referrals).

Next, you’ll be prompted to submit your application online, by mail, or in person. 

Step 5: Verification and Approval

AvMed may need time to verify your information prior to approval. Once approved, AvMed will confirm your enrollment and provide a welcome package that includes information about your coverage and membership ID cards. 

AvMed Insurance and Grow Therapy

AvMed insurance is an excellent solution for anyone in the Florida area looking to receive comprehensive mental health coverage, tailored health plans, and cost-effective solutions. 

In order to make the most of your coverage, you can find an in-network AvMed therapist with Grow Therapy. Simply choose your specific requirements, pick a therapist who meets your needs, and book a session directly through our website.

FAQs

  • AvMed offers several Medicare Advantage plans, including wellness programs, prescription drug coverage, substance abuse services, and more. Availability of plans may vary depending on location and chosen health care provider.

  • AvMed covers a wide range of general and specialized services including primary care physician visits, hospital services, urgent care, prevention care, mental health and behavioral health services, retail clinics, wellness programs, and home health care services.

  • Yes, some AvMed plans require referrals from your primary care physician to receive specialized treatment. Often, PPO and POS plans have greater flexibility and may not require referrals while HMO plans do.

  • Maximum out-of-pocket limits are set by each health insurance plan. Once you reach your limit, your AvMed healthcare plan covers 100% of your in-network medical care expenses for the rest of the calendar year to aid in the cost of follow-up visits.

  • Proof of coverage, also known as a Certificate of Coverage, is a document provided by AvMed that verifies your coverage. As an active AvMed member, you may need to provide this document when seeking care, submitting claims, or verifying coverage with healthcare specialists.

  • Visit www.avmed.org or call 1-800-477-8768.

About the author
derek lee grow therapy Derek Lee, VP of Insurance Operations

Derek Lee is Grow Therapy's Vice President of Insurance Operations, overseeing payor relations and success, credentialing and enrollment, new payor launch, revenue cycle management and billing, and insurance operations data analytics.

This article is not meant to be a replacement for medical advice. We recommend speaking with a therapist for personalized information about your mental health. If you don’t currently have a therapist, we can connect you with one who can offer support and address any questions or concerns. If you or your child is experiencing a medical emergency, is considering harming themselves or others, or is otherwise in imminent danger, you should dial 9-1-1 and/or go to the nearest emergency room.

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