Insurance Plans We Participate With
Complete Health Wellness Group is credentialed with several insurance networks for outpatient mental health therapy services. However, seeing a familiar carrier name on your insurance card doesn't always mean you have the same coverage as others with that carrier.
This page explains our network participation and—just as importantly—why verifying your specific plan is essential before your first appointment.
Why Your Specific Plan Matters
Insurance is more complicated than it appears. Two people with "CareFirst" cards can have completely different coverage, copays, and network access. Here's why:
Different Plan Types Under One Carrier:
CareFirst (or any carrier) offers Commercial plans, Medicare Advantage, Medicaid (HealthChoice), and Maryland Health Connection (ACA) plans. Each has different networks, benefits, and rules. Being in-network for commercial plans does NOT automatically mean we accept Medicare Advantage or Medicaid from that same carrier.
Self-Funded Employer Plans:
About 67% of workers with employer coverage have "self-funded" plans. Your card might say "Aetna," but your employer—not Aetna—decides your benefits. Aetna just processes the paperwork. Your copays, deductibles, and covered services could be completely different from a "real" Aetna plan.
Behavioral Health Carve-Outs:
Many employers use a separate company to manage mental health benefits. Your medical card might say "UnitedHealthcare," but your mental health benefits might be managed by Optum, Magellan, or Carelon. These companies have different provider networks—a therapist can be in-network for medical but out-of-network for behavioral health.
Always verify your specific plan's coverage before scheduling. Learn how to verify your benefits →
Understanding Your Insurance Card
Why the logo on your card doesn't tell the whole story
When you show us your insurance card, we see a carrier logo. But that logo can represent many different arrangements:
Same Logo, Different Realities
A "CareFirst BlueChoice" card could be:
- Option A: A fully-insured CareFirst small group plan (CareFirst sets the benefits)
- Option B: A self-funded Fortune 500 employer using CareFirst's network (employer sets the benefits)
- Option C: Federal Employee Program (FEP) using CareFirst (federal government sets the benefits)
- Option D: CareFirst Medicaid/HealthChoice MCO (state sets the benefits)
All four show the same CareFirst logo, but the benefits, copays, and even whether we're in-network can be completely different.
Real-World Example
Scenario: A patient calls and says, "I have Aetna. Are you in-network?"
The answer depends on:
- Is it employer-sponsored commercial or ACA marketplace?
- Is the employer plan self-funded (employer decides benefits) or fully-insured (Aetna decides benefits)?
- Does the employer carve out mental health to a separate company?
- Is it Aetna Medicare Advantage?
- Is it Aetna Better Health (Medicaid)?
We might be in-network for some of these and out-of-network for others—despite all having "Aetna" on the card.
Our Network Participation
Insurance networks we are credentialed with for outpatient mental health
We maintain active credentialing with the following insurance networks. If your plan uses one of these networks, we can likely see you as an in-network provider—but you should still verify with your specific plan.
Commercial & Employer Plans
Employer-sponsored and individual commercial insurance
- Aetna (commercial plans)
- CareFirst BlueCross BlueShield (commercial plans)
- Cigna / Evernorth (commercial plans)
- United Healthcare / Optum (commercial plans)
- Johns Hopkins EHP (commercial plans)
- [Additional carriers - verify with practice]
What this means:
If your employer offers coverage through one of these carriers, and your plan uses their standard network, we should be in-network. Self-funded employer plans using these carriers' networks are typically included, but always verify.
Maryland Health Connection (ACA Exchange)
Plans purchased through the state exchange marketplace
- CareFirst (Exchange plans)
- [Other Exchange plans - verify with practice]
Maryland Exchange Carriers (2025):
CareFirst, UnitedHealthcare, Kaiser Permanente, Aetna, and Wellpoint all offer plans on Maryland Health Connection. Our participation varies by carrier—contact us to confirm.
Behavioral Health Networks
Some employers use separate behavioral health networks
- [Behavioral health carve-outs - verify with practice]
Self-Funded Employer Plans
Behavioral Health Carve-Outs
When your mental health benefits are managed separately
Many employers "carve out" mental health benefits to a specialized behavioral health company. This means your medical and mental health coverage might be managed by different organizations with different provider networks.
Major Behavioral Health Carve-Out Companies
Optum Behavioral Health
Part of UnitedHealth Group. Manages behavioral health for many large employers regardless of their medical carrier.
Magellan Health
Part of Centene. Strong presence in public sector and Medicaid behavioral health management.
Carelon Behavioral Health
Formerly Beacon Health Options. Part of Elevance (Anthem). Manages behavioral health for many Blue Cross plans.
Lyra Health
Newer player focused on employer mental health benefits. Growing presence with tech companies.
How to Know If You Have a Carve-Out
Check your insurance card carefully. Look for these signs:
- Separate phone number labeled "Behavioral Health" or "Mental Health" on the back
- Different company name in small print for mental health services
- Separate website for mental health provider directories
If you see any of these signs, call that behavioral health number to verify our network status—not the main medical number.
The Hidden Carve-Out Problem
What sometimes happens:
- Patient's card says "Aetna"
- Provider verifies with Aetna—yes, patient is an active member
- Services provided, claim submitted to Aetna
- Claim denied: "Mental health benefits managed by separate entity"
- Mental health was actually carved out to Meritain, Lucet, or another company
This is why we encourage patients to verify their mental health benefits specifically—not just their general insurance coverage.
Plans We Do Not Currently Participate With
Understanding why certain plans require separate credentialing
We are not currently in-network with the following plan types. This isn't a reflection on the value of these plans or their members—each requires separate credentialing processes, different reimbursement structures, and sometimes different clinical requirements.
- Original Medicare (Parts A & B)
- Medicare Advantage plans
- Maryland Medicaid (HealthChoice)
- TRICARE
- [Other non-accepted plans - verify with practice]
Why Medicare Requires Separate Credentialing
Medicare (both Original and Advantage plans) is a federal program with its own credentialing process through CMS (Centers for Medicare & Medicaid Services). Being credentialed with commercial insurance carriers doesn't automatically include Medicare. Additionally, Medicare Advantage plans—even those offered by carriers we work with—require separate contracts with each MA plan.
Why Medicaid Works Differently
Maryland Medicaid operates through Managed Care Organizations (MCOs) like CareFirst Community Health Plan, UnitedHealthcare Community Plan, and others. Each MCO has separate provider networks and credentialing requirements. A provider can be in-network with CareFirst commercial plans but not CareFirst Medicaid—they're essentially different insurance products.
Out-of-Network Options Available
Understanding Self-Funded Employer Plans
Why 67% of workers have plans that work differently than expected
Self-funded (also called "self-insured") plans are far more common than most people realize. About two-thirds of workers with employer coverage are in self-funded plans, and among large employers (200+ workers), that number exceeds 80%.
How Self-Funded Plans Work
Fully-Insured Plan (Traditional)
- Employer pays premium to insurance company (e.g., Aetna)
- Insurance company pays claims from its funds
- Insurance company designs the benefits
- Subject to state insurance regulations and mandates
Self-Funded Plan (ASO)
- Employer hires carrier for "Administrative Services Only"
- Employer pays claims from its own funds
- Employer designs the benefits (with carrier input)
- Governed by federal ERISA law, not state regulations
The Network Lease Arrangement
In a self-funded ASO arrangement, here's what the insurance carrier actually provides:
- Network access: The employer "rents" the carrier's provider network
- Claims processing: Carrier reviews and processes claims
- ID cards and portals: Looks like regular insurance to you
- Customer service: You call the carrier's number
What the carrier does NOT do: Pay the actual claims. When a claim is approved, money comes from your employer's bank account—not the insurance company's.
How to Identify a Self-Funded Plan
Check your insurance card and plan documents for these clues:
| Where to Look | Self-Funded Indicator |
|---|---|
| ID Card (back) | "Administered by [Carrier]" instead of "Insured by" |
| ID Card (fine print) | "Administrative Services Only" or "ASO" |
| ID Card disclaimer | "[Carrier] assumes no financial risk" or "provides claims payment services only" |
| Card branding | UMR branding = 100% self-funded (UMR is UHC's TPA) |
| Summary Plan Description | "Benefits paid from general assets of the employer" |
| SPD legal section | References to "ERISA" without mention of state insurance department |
Easiest Way to Find Out
What Self-Funded Status Means for You
Benefits Can Be Customized
Your employer can choose different copays, deductibles, covered services, or exclusions than the carrier's standard plans. Two coworkers at different companies—both with "CareFirst" cards—might have completely different mental health coverage.
State Mandates May Not Apply
Self-funded plans are governed by federal ERISA law, not state insurance regulations. Maryland insurance mandates (like certain coverage requirements) apply to fully-insured plans but generally not to self-funded employer plans. Your employer decides what to cover.
Different Appeal Rights (Important!)
If a claim is denied under a self-funded plan:
- You appeal through the plan's internal process first
- External appeals go to the U.S. Department of Labor, not the Maryland Insurance Administration
- Limited legal remedies—courts can only award the cost of the denied benefit, not punitive damages
- State insurance commissioner has no jurisdiction over self-funded plans
Level-Funded Plans (Small Business)
If you work for a smaller employer (under 100 employees), you might have a "level-funded" plan. These look like traditional insurance (fixed monthly payments) but are legally self-funded:
- Employer pays fixed monthly amount (admin fee + claims pot + stop-loss premium)
- If claims are low, employer may get a refund (savings)
- If claims are high, stop-loss insurance covers the excess
- Legally self-funded—ERISA applies, not state insurance law
About 36-38% of small firm workers are now in level-funded arrangements.
How to Verify Your Coverage
Different verification paths for different situations
The best verification approach depends on your plan type. Here's how to get accurate information:
Standard Commercial/Employer Plan
- Call the Member Services number on your card (use Behavioral Health number if listed separately)
- Ask if Complete Health Wellness Group at [ADDRESS] is in-network for outpatient mental health
- Verify your deductible, copay, and any session limits
- Get a call reference number for documentation
Self-Funded Employer Plan
- First: Call the carrier number on your card to verify network status and claims processing
- Second: Check with your HR/benefits department about specific benefit levels (copays, limits, exclusions)
- Request your Summary Plan Description (SPD) for official benefit details
- Document everything—both carrier and employer information
If You Have a Behavioral Health Carve-Out
- Look for a separate "Behavioral Health" or "Mental Health" phone number on your card
- Call that number—not the main medical number
- Ask specifically about outpatient therapy with licensed therapists (LCPC, LCSW)
- Verify prior authorization requirements for therapy sessions
Medicare or Medicaid Plans
We are not currently credentialed with Medicare (Original or Advantage) or Maryland Medicaid. If you have these plans, please see our out-of-network options or contact us to discuss self-pay rates.
Want help verifying? Our billing team can assist with benefits verification before your first appointment. Contact us with your insurance information.
Questions About Your Coverage?
We're here to help
Insurance is confusing—we understand. If you're unsure whether we participate with your plan, or if you need help understanding your coverage, contact our billing team. We're happy to help you figure out your options.
Contact our billing team:
[PHONE NUMBER]
[EMAIL]
What to Have Ready When You Call Us
- Your insurance card (front and back)
- The name of your employer (if employer-sponsored coverage)
- Whether you know if it's self-funded or fully-insured
- Any separate behavioral health card or information, if you have one