Does Insurance Cover TMS Therapy?
Transcranial Magnetic Stimulation (TMS) therapy is a non-invasive therapy gaining traction as an FDA-approved treatment for those suffering from depression, particularly patients that have not achieved desired outcomes from traditional treatment plans. Although TMS is often a great way for patients to find relief, many wonder about the cost and whether their insurance will cover TMS therapy. Understanding coverage for TMS is important for patients to make informed decisions and fully understand all their options before starting treatment.
The Cost of TMS Therapy
TMS therapy involves repeated sessions spanning several weeks. The price per session varies by clinic, location, and any extra services provided. After the full treatment period is complete, the cost can reach several thousand dollars. That price can be very daunting up front, which is why insurance coverage is such an important factor when deciding on TMS as a treatment.
How Insurance Coverage Typically Works
The good news is that most of the leading health insurance companies are covering TMS treatment, especially in cases of Treatment-Resistant Depression (TRD). Insurance companies are acknowledging the importance of TMS as a medically necessary treatment for patients who can’t achieve enough relief from medications or therapy. Typically, the right coverage is granted when all conditions have been met to ensure TMS is being prescribed appropriately to those who truly need it.
Common Requirements for coverage include:
- A diagnosis of major depressive disorder
- Evidence that at least two antidepressant medications were tried without success
- Trial of psychotherapy with a psychotherapist
- Must be over the age of 18
Variations of Coverage
It’s important to note that insurance companies can have their own additional requirements, but these are some of the most common requirements for most health insurances. Contact your insurance provider to verify that you are eligible under your specific insurance plan. Insurance coverage varies by insurance provider, plan type, and even from state to state.
For instance, some plans may pay for the entire treatment, while others may require you to make a co-pay or deductible, and some plans may even have a limit on the number of sessions that they will pay for. For the vast majority of plans, patients need to obtain prior authorization before starting TMS therapy, meaning your insurance has to approve treatment in advance. This process helps establish that your circumstances justify the need for TMS therapy.
Finding Clinics that Accept Your Insurance
Probably one of the most important things to do is find a clinic that takes your insurance. Fortunately, MDDCare makes it simple for you to search for TMS providers based on where you live and what insurance you have. This way you can save time and avoid unexpected costs, so you can focus your energy on treatment.
Why Coverage Matters
Insurance providers cover TMS because of its well established efficacy in treating patients with depression who have not responded to medication. Research indicates that TMS provides substantial relief for many people, which would result in improved quality of life and reduced long-term healthcare costs associated with depression. By acknowledging TMS as a medically necessary treatment, the insurance companies are making evidence-supported investments into the mental health of their members.
Take the First Step
If you, or someone close to you, is thinking about TMS, don’t let uncertainty about insurance stand in the way. Call your insurance provider to clarify the necessary requirements of your particular plan well in advance so that you can save time and energy. You can also use MDDCare to find clinics in your area that accept your insurance, so you can easily reach trusted providers.