Insurance Guide
Major depressive disorder (MDD) affects over 16 million Americans each year, according to the National Institute of Mental Health. That’s almost 7% of the U.S. population – but fortunately, there’s a relatively new treatment on the market that’s having a very positive effect on those who’ve tried it.
Transcranial Magnetic Stimulation (TMS) – is an amazing new form of therapy for those with persistent depressive symptoms. It involves a non-invasive method with the use of a device that’s placed on a patient’s head which then sends electrical pulses into the brain to stimulate serotonin and norepinephrine reception.
The procedure occurs in daily sessions for approximately 6 weeks, with treatments tapering off as that window comes to a close. The patient may leave the doctor’s office on their own and return to their daily lives.
INSURANCE COVERAGE
More and more providers are realizing the importance and efficacy of TMS therapy. We expect coverage for TMS therapy to expand in the foreseeable future, especially as the benefits of TMS are seen for other disorders and ailments.
It is key to use a TMS-prescribing psychiatrist who will determine if you are a good candidate and work with the insurance company to find out if you are covered. You will also want to choose a TMS-prescribing psychiatrist who can help in securing coverage, including writing letters on your behalf to argue for coverage.
Our team can assist you with:
- Verification and determination for candidacy
- Filing the claim with your insurance company
- Informing patients of their TMS benefits
Happily, most insurance companies cover TMS (with various conditions and/or restrictions) and require prior authorization. Copays and deductibles also vary and are subject to the conditions laid out in each individual’s own insurance policy.
Some insurance companies who currently cover TMS include:
Anthem – Anthem is one of the country’s biggest health insurers, with over 34 million members. Anthem issued coverage for TMS Therapy starting on August 13, 2012.
Anthem members can apply for preauthorization directly through their doctor’s office.
Anthem Coverage Description
Covered for Major Depressive Disorder (MDD).
Preauthorization is required.
Benefits vary by state and insurance plan.
For provider codes, coverage and limitations, view the complete explanation of benefits for Anthem Blue Cross/Blue Shield.
Blue Cross – The oldest and largest health insurance group in the United States, Blue Cross and Blue Shield, provides insurance coverage to one in every three Americans. BCBS issued coverage for TMS Therapy effective on August 13, 2012.
BCBS policy states that beneficiaries may be eligible for TMS if they have depression or a variant of the disease.
BCBS Coverage Description
Members must meet additional criteria outlined in the policy.
TMS benefits are dependent on state and specific insurance plans.
For provider codes, coverage, and limitations view the complete explanation of benefits for Blue Cross/Blue Shield.
Blue Shield– Blue Shield is under the umbrella of Blue Cross Blue Shield, but there are companies designated specifically as such in the following areas:
- Blue Shield of California
- Regence Blue Shield of Washington
- Regence Blue Shield of Idaho
- Highmark Blue Shield of Pennsylvania
- Blue Shield of Northeastern New York
CIGNA – Cigna began offering TMS coverage in 2016.
Health Net – Health Net began offering TMS coverage in 2012.
TRICARE – Tricare added TMS coverage in 2016. Adults only.
United Healthcare (OPTUM) – The behavioral health services and plans for United HealthCare members are usually managed by OPTUM. Be aware that each plan’s coverage regarding TMS therapy varies. You should look into the benefits allowed within your specific plan in order to find out what benefits and coverage are available for TMS therapy.
If the patient is currently receiving electroconvulsive therapy, TMS may be considered reasonable and necessary as a less invasive treatment option.
This is just a partial list. Please contact us or your insurance provider to see what is covered.
NO INSURANCE
If you don’t have insurance, we’re happy to discuss your situation, review your history, and discuss costs confidentially with you.
We can go over financing and payment plan options.