Mental Health Benefits
Real support, from routine therapy to higher-level care.
Caring for your mental health is part of caring for your whole health. Solo covers a broad range of behavioral health services — therapy, psychiatry, virtual care, and structured treatment programs — so you can get support that fits your needs, your schedule, and your budget. Here's how it all works.
- Individual and family therapy with licensed clinicians (LCSW, LMFT, LPC, psychologist).
- Psychiatric consultations and ongoing medication management.
- Evidence-based treatments like CBT and DBT when medically necessary.
- Outpatient visits are covered up to 40 per year for each covered individual.
- Video or phone therapy and psychiatry with in-network providers are covered the same as in-person care unless noted in your Plan Summary.
- Great for convenience, continuity, and access to specialty care wherever you live.
- Intensive Outpatient Programs (IOP), Partial Hospitalization Programs (PHP), and other structured day programs.
- Prior authorization is typically required for these services and for most inpatient behavioral health admissions.
- Hospitalization or residential treatment for acute mental health or substance use needs.
- Emergency services are always treated as in-network — go to the nearest ER. Ongoing stays generally require authorization.
Outpatient therapy & psychiatry
Virtual / telehealth visits
Intensive / structured programs (prior authorization required)
Inpatient & crisis stabilization (prior authorization required)
- Scheduled virtual visits with licensed professionals, ranging from $0–$95 per visit.
- Bella, an anonymous AI companion for working through depression and anxiety — available whenever you need it.
- Clever Connections peer-to-peer support, connecting you with people who understand what you're going through.
- Support across a wide range of needs — grief, stress, anxiety, depression, addiction, eating disorders, relationship issues, and more.
Beyond your plan's behavioral health coverage, every Solo membership includes virtual mental health through Clever Health — often the fastest and most affordable way to start:
Access it through the Clever Health app — sign in with your last name, date of birth, and ZIP code.
Mental health care follows the same simple cost structure as the rest of your Solo plan: what you spend on covered care applies toward your deductible, and once you reach it, eligible care is paid at 100% for the rest of the plan year — your deductible is also your out-of-pocket maximum.
In-Network
- Care is priced at negotiated network rates, so your spending before the deductible stays as low and predictable as possible.
- In-network providers bill the plan directly and won't balance bill you beyond the plan's rates.
- Teletherapy with an in-network clinician is covered the same as in-person care.
Out-of-Network
- You can see out-of-network providers — claims are priced under Reference-Based Pricing, which sets a fair allowed amount for each service.
- If a provider charges above the allowed amount, they may bill you the difference. For recurring therapy or psychiatry visits, that can add up — which is why in-network is usually the smarter route.
- If a provider won't bill the plan directly, you (or they) can submit a detailed bill — see self-submitting below.
- Prior authorization rules still apply — especially for IOP, PHP, residential, and inpatient stays — whether in- or out-of-network.
You'll almost always save money — and avoid balance bills — by choosing in-network therapists and psychiatrists. It also means less paperwork, because in-network providers bill the plan for you. No referral is ever needed.
- Search the network. Use the Multiplan PHCS (now Claritev) Provider Search Tool and filter by "Behavioral Health," "Mental Health," or "Psychiatry."
- Confirm before your appointment. Ask the office directly whether they're in-network with Multiplan PHCS — directories can lag.
- For telehealth, ask if the same network status applies to virtual visits and whether they'll bill your plan.
Rather have us do it? Solo Concierge can find in-network mental health providers and verify participation for you.
Routine outpatient therapy generally doesn't need advance approval. These services do:
- Inpatient psychiatric or substance use admissions
- Residential treatment
- PHP and IOP
- Extended psychological testing beyond routine evaluation
What to do
- The treating facility or provider usually requests authorization on your behalf.
- Call the number on your ID card to confirm authorization is on file before care begins.
- Using an out-of-network facility? Be extra sure prior authorization is approved first — it protects you from a potential denial or reduced payment.
- Medications prescribed by your psychiatrist or primary care provider are covered under your plan's prescription benefit — the formulary lists every covered drug and its tier.
- Some medications may require prior authorization or have quantity limits — the FairosRx portal or app is the fastest way to check.
- For the best price, ask about generics or preferred brands, and make sure your pharmacy participates with FairosRx.
- Collect the paperwork. Get an itemized receipt or superbill from your provider — it needs the diagnosis and procedure codes, dates of service, and the provider's NPI and tax ID.
- Submit through the Member Portal. Log in to your Member Portal and follow the claims submission guidance — it walks you through uploading your documentation step by step. Submit within the timely filing window in your SPD — late claims are denied.
- Keep copies of all bills and documentation until the claim is fully processed.
- Solo Concierge — your first stop for coverage, network, or benefits questions. Call or text 646-328-6968 or send a request online.
- Vault Admin Services — for claims and authorization status, at 888-211-5706. Entering an IOP, PHP, or inpatient program? Ask about care coordination through the Vault Cares Network to smooth authorizations and transitions of care.
- Appeals — if a claim is denied, you have the right to appeal. Follow the instructions on your Explanation of Benefits and include supporting clinical notes from your provider. Vault Admin Services can walk you through the process.
Do I need a referral to see a therapist or psychiatrist?
No. Solo never requires referrals — for any specialist, including mental health.
Are teletherapy sessions covered?
Yes — with in-network providers, teletherapy is covered the same as in-person care. And your membership includes virtual mental health through Clever Health, often the fastest way to get started.
Can I see an out-of-network therapist?
Yes. Claims are priced under Reference-Based Pricing, and you may pay more if the provider charges above the allowed amount. For recurring visits, in-network usually saves real money.
Is there a limit on therapy visits?
Outpatient mental health visits are covered up to 40 per year for each covered individual. There are no dollar caps on what the plan pays.
Do higher-level programs need authorization?
Yes — IOP, PHP, residential, and inpatient behavioral health typically require prior authorization. The treating facility usually handles the request, and you can confirm by calling the number on your ID card.