How to verify your NJ FamilyCare (Medicaid) mental health benefits.
NJ FamilyCare is the New Jersey Medicaid program, and it's administered through five managed care organizations: Horizon NJ Health, Aetna Better Health of New Jersey, UnitedHealthcare Community Plan of NJ, Wellpoint (formerly Amerigroup), and FidelisCare. All five cover therapy, psychiatry, and medication management at $0 to the member when you see an in-network provider. The challenge isn't whether you're covered — it's confirming that the clinician you want to see takes your specific MCO before you book. This guide walks through the call so the answer is settled in ten minutes. Positive Reset Eatontown is in-network with all five MCOs.
The call, in order.
Total time: about 10 minutes for most plans, 24 hours if the rep has to call back.
Find your MCO on your member card
Your NJ FamilyCare member card lists the managed care organization name and the member services phone number on the back. The MCO is the entity that actually handles your benefits — it's not 'NJ FamilyCare' in the abstract, it's one of the five named plans. If you only have the paper enrollment letter, the MCO is also named there.
Call your MCO's member services line
Use the number on the back of the card, not a generic NJ FamilyCare number. The five member services lines: Horizon NJ Health 1-800-682-9090. Aetna Better Health of New Jersey 1-855-232-3596. UHC Community Plan 1-800-941-4647. Wellpoint 1-800-600-4441. FidelisCare 1-888-353-0571.
Ask the rep to confirm in-network status
Give the rep the clinic name (Positive Reset Eatontown) and the address (615 Hope Rd, Suite 3B, Eatontown, NJ). Ask if we are in-network for outpatient mental health for your specific MCO. The rep can confirm in under five minutes — they look up the provider directory in real time.
Open the NJ FamilyCare (Medicaid)portal → (opens in new tab)
Confirm copay and any cost-share
Most NJ FamilyCare plans charge $0 for outpatient mental health. Confirm there is no copay for therapy or psychiatry, no prior-authorization requirement for the first visit, and no annual visit cap that would limit ongoing care.
Ask whether telehealth is covered at parity
Every NJ FamilyCare MCO covers telehealth at parity with in-person visits, but the rep should confirm it for your specific plan so there's no surprise on the first claim. Telehealth is delivered statewide from our Eatontown office.
Note the member ID and group number
Write down (or photograph) the front of your card — member ID, group number if listed, and the MCO name as printed. When you call us at (732) 724-1234 to book, we'll re-verify with the same information so there's no gap between what the MCO told you and what we bill.
Exactly what to ask the rep.
Copy this list before the call. Each item is the kind of answer that should be on the line with you, not in a follow-up email a week later.
- Is Positive Reset Eatontown in-network for outpatient mental health under my plan?
- What is the copay for therapy and psychiatry visits?
- Is prior authorization required for the first visit?
- Is there a session limit per year for outpatient mental health?
- Is telehealth covered at the same rate as in-person?
- If I need TMS later, what's the prior-authorization process?
- How long is benefit verification good for once issued?
Plan-specific notes.
NJ FamilyCare's five MCOs are operationally distinct even though the underlying Medicaid coverage is identical. Horizon NJ Health administers behavioral health in-house, which typically means faster prior-authorization turnarounds. Aetna Better Health and UHC Community Plan are separate products from the commercial Aetna and UnitedHealthcare plans — having a commercial card from the same brand does not confirm Medicaid coverage. Wellpoint members may still carry an Amerigroup-branded card after the 2024 rebrand; both reach the same support team. FidelisCare entered NJ in 2022 and uses a Centene-administered behavioral-health partner.
If you're between MCOs during open enrollment, ask the new MCO whether they'll honor an in-progress treatment plan from the prior one — most do, but the documentation has to be filed proactively. We can help with that filing on the first call.
For general NJ FamilyCare program questions (eligibility, enrollment, switching MCOs), call NJ FamilyCare directly at 1-800-701-0710 or visit njfamilycare.org. For Positive Reset Eatontown verification specifically, your MCO's member services line is the faster path.
We can run the verification for you.
Call us with your member ID and we’ll do the verification call ourselves — usually 5–10 minutes for most plans, 24 hours for plans that require a callback. You’ll get the copay and coverage answer before you book your first visit.
Verifying a different plan?
Other things people ask.
Do you accept NJ FamilyCare (Medicaid)?
Yes. We accept all five NJ FamilyCare managed care organizations: Horizon NJ Health, Aetna Better Health of New Jersey, UnitedHealthcare Community Plan of New Jersey, Wellpoint, and FidelisCare. NJ FamilyCare members pay $0 out-of-pocket for therapy, psychiatry, and medication management at our clinic. You'll need your member ID card for your first visit; we verify your eligibility before you arrive.What does NJ FamilyCare cover for mental health?
NJ FamilyCare covers individual therapy, family therapy, group therapy, psychiatric evaluations, medication management, partial hospitalization, and crisis services. Coverage of telehealth, inpatient care, and substance use treatment varies by MCO and plan tier. Specific session limits and prior-authorization requirements differ by MCO — see the [NJ FamilyCare benefits handbook](https://www.njfamilycare.org) or ask us at intake.What is the No Surprises Act and how does it apply?
The No Surprises Act (CMS) protects you from getting an unexpected bill for in-network care. At Positive Reset Eatontown, we verify your insurance benefits before your first visit and tell you exactly what you'll pay — no surprise bills. If you're a self-pay patient, you'll receive a Good Faith Estimate before treatment begins. See our [No Surprise Billing](/insurance/no-surprise-billing/) page for the full policy.How do I verify my insurance before booking?
Call us at (732) 724-1234. Have your insurance card ready — we'll need the member ID, group number (if any), and the plan name on the front of the card. We verify benefits in 5–10 minutes for most plans, or within 24 hours for plans that require a callback to the insurer.
Last updated: 2026-05-23