Is Ketamine Therapy Covered By Insurance? Understanding the General Policies from Insurance Companies in California
Depression significantly impacts a person’s ability to function. In 2022, 1 in 26 Californians experienced severe enough mental health symptoms that they were unable to carry out daily responsibilities. For the most part, depression responds well to traditional treatment modalities of therapy and antidepressant medications.
However, around 30% of people with this condition have what is known as treatment-resistant depression. This results in them being unable to find any sense of relief from their symptoms despite trying multiple options. This doesn’t mean that they are out of choices. One potential alternative they can try at that point is ketamine therapy, which is an effective treatment method that has been shown to reduce severe depression symptoms.
Because of this, many people have questions regarding this type of treatment before starting. At BNI Clinics, we want to ease your concerns by helping you learn more about this often a lifesaving option. The most significant question we get asked is, “Is ketamine therapy covered by insurance?” We will answer that question in this blog.
What Is Ketamine Therapy? What Does It Treat?
Before knowing if ketamine therapy is covered by insurance, it is important to know what it is. Ketamine is an anesthetic that has been shown to have benefits in reducing symptoms associated with many types of mental health conditions like anxiety or bipolar disorder. Ketamine therapy is most commonly used to provide relief for people with depression who haven’t had much success with other forms of treatment. During treatment, people are given a small dose of the medication through either an IV injection or a shot. They are also required to participate in other treatment methods as well.
A Tool For Treatment-Resistant Depression: How Effective Is Ketamine Therapy?
Depression and other conditions like it are challenging to live with, and ketamine therapy can be an effective tool for those who can’t find healing through different treatment modalities. One study of 714 people found that 26% of their participants experienced a remission in their depression symptoms after trying ketamine therapy for 12 months. This is comparable to other studies that found 29% to 30% efficiency. In another study, they found that through maintenance of ketamine treatments, depression symptoms continued to improve for over 13 months in 21% of participants, which shows that ketamine therapy is not only effective in the initial sessions but also remains so in the long term. While it is effective, the exact experience someone has varies from person to person.
Does Your Insurance Cover Ketamine Therapy? How to Know For Sure
Ketamine therapy is not covered by all insurance companies or possible health plans. This is because they are not required to do so. As of 2023, many insurance companies are reluctant to cover ketamine therapy despite the growing interest and benefits it has had. Insurance company policies can vary from person to person, and this generalization does not necessarily indicate everyone’s plans. It is essential to check with your specific policy.
In some cases, your insurance company might cover ketamine therapy for another condition, such as chronic pain. If you qualify for that specific coverage, the clinic might be able to use that code if it is related, but it is not guaranteed approval. Suppose your insurance plan does cover ketamine for depression or mental health purposes. In that case, it will be explicitly stated in your agreement with them. Below are California’s most common insurance companies and their general policies regarding ketamine therapy.
Blue Cross Blue Shield: Ketamine Therapy Policy
Blue Cross Blue Shield considers ketamine therapy for chronic pain and psychiatric disorders to be investigational. It does not recognize it as a standard medical care option, which is not typically covered in most plans. As mentioned above, specific plans may differ from this decision. Suppose it is determined that ketamine treatment is medically necessary based on its standards. In that case, it may be approved but not warranted.
United HealthCare: Ketamine Therapy Policy
Generally, United HealthCare recognizes ketamine therapy as a proven treatment option when all of its criteria are met. The extensive list of criteria they require is to determine if this treatment is medically necessary for an individual. Not meeting these criteria may result in coverage for the therapy being declined. However, meeting the requirements does not automatically assure that you will be approved for ketamine therapy, as this varies depending on your specific benefit plan. You can find this information in your benefit plan document.
Aetna: Ketamine Therapy Policy
Like Blue Cross Blue Shield, Aetna views ketamine treatment as investigational. Your specific plan might cover it, but it is not guaranteed to be approved.
HealthNet: Ketamine Therapy Policy
HealthNet only approves the nasal spray option if you meet their requirements. These prove to them that it is medically necessary and ensure that you remain compliant throughout your treatment. Not meeting 1 of these guidelines will result in your coverage being declined. Like with all insurance policy plans, this can vary, and even if you meet their general criteria, you might not be approved.
Anthem: Ketamine Therapy Policy
Anthem typically only approves ketamine therapy for chronic pain. The exact coverage policy regarding the medication and whether it is approved for depression or another mental health condition depends on a member’s benefit plan. They are not required to cover ketamine therapy for mental health reasons. It can also be subject to a clinical review if specific criteria are met. If the requirements are not met, it will not be approved.
Find Out If You Qualify For Ketamine Therapy in Los Angeles Today
If you have found that depression or another mental health condition’s symptoms are not improving despite the numerous treatment options you have tried, it can feel frustrating and like you have lost all sense of hope. Ketamine therapy is an option that can provide you with relief. Receiving a diagnostic evaluation for a mental health condition is the first step in knowing if you will qualify for this type of treatment and how it might be accessible for you.
BNI Clinics, located in the Los Angeles area, provides dedicated psychiatric treatment that includes diagnoses, testing, and individualized plans for children, adolescents, and adults. Our evidence-based therapies, like ketamine therapy, ensure our clients have access to the tools that will provide them with a more successful outcome to healing. Call us at 310-691-5005 for inquiries or to get started today.
BNI Clinics: Science-based, evidence-backed, compassion-led.
