Does Insurance Cover TMS? A Guide to Navigating Costs and Coverage
Are you living with depression or obsessive-compulsive disorder (OCD) that medication and therapy haven’t been helping with? Have you, for years, blamed yourself for symptoms that have held you back from living the life you deserve? If this sounds like you, Transcranial Magnetic Stimulation therapy might be covered by your insurance company.
TMS is a safe, noninvasive treatment for certain psychiatric and neurological conditions that uses electrical pulses to stimulate neurons in the brain. It has been shown to be an effective treatment for treatment-resistant depression, OCD, posttraumatic stress disorder, Tourette’s, anxiety, chronic pain, bipolar disorder, movement disorders, including Parkinson’s, and smoking. Insurance companies may not cover TMS for all conditions, however.
At BNI Clinics, our triple-board-certified psychiatrists can prescribe TMS therapy and perform it in-house. The cost will depend on whether your specific insurance plan covers the treatment.
Common Requirements for TMS Insurance Coverage
The requirements for getting TMS covered vary by insurance company and plan, but most major insurance providers cover TMS for major depressive disorder (MDD) and OCD with certain additional stipulations. Here are some of the common requirements:
- Diagnosis of depression or OCD: Insurance companies want to know you have been evaluated and diagnosed by a doctor for one of the conditions they deem fit for TMS treatment. Some insurance may only cover TMS for depression, but the Food and Drug Administration has approved TMS for OCD treatment.
- Failed pharmaceutical attempts at treatment: Insurance wants to see that you have exhausted your other treatment options. Typically, they want to see that you’ve tried at least 2 antidepressants from two different classes of antidepressants and that you took the medications for a set amount of time, or that your body cannot tolerate at least 4 different antidepressants. These numbers vary by company and plan.
- Therapy has not been effective: The required lengths of time or number of visits that qualify as an attempt at psychotherapy vary by insurance company, but they usually want to see that you’ve tried this proven method of managing depression and OCD.
- Previous TMS treatments were effective: This is a good indicator that you’re a great candidate for TMS again.
- You are not pregnant, epileptic, or experiencing substance use disorder: These and several other conditions disqualify you from TMS coverage.
Tips for Navigating Insurance Coverage for TMS Therapy
While TMS is covered by most insurance companies, there are many conditions to the coverage, which makes the treatment harder to access than other treatments. In order to optimize your chances of getting TMS covered, keep meticulous records of your past treatments, especially pharmaceuticals and therapy. According to research, the criteria insurance providers require to cover TMS, such as a certain number of rounds of trying antidepressants, are outdated interpretations of scientific research. Until the insurance companies catch up, however, documentation is key.
If you get denied coverage, you can always make an appeal. Insurance companies generally cover services that are “medically necessary,” and if you can prove that TMS is medically necessary through a letter from your physician and documentation of past treatments, you may be able to get coverage.
How to Check If Your Insurance Covers TMS
Unsure if your insurance covers TMS or the specifics around the coverage? Contact your human resources department if your insurance is through your workplace, or call your insurance company directly.
How Much Will TMS Therapy Cost with Insurance Coverage?
Depending on your insurance company and plan, there may be out-of-pocket costs for TMS. This will vary based on if TMS is covered for your mental health condition and what your deductible and copay policies are. If it is not covered under your insurance, inquire your service provider about payment plans.
Get Started With TMS Therapy at BNI Clinics in California
Our TMS treatment at BNI clinics starts with a metal magnet being placed on your head. This transmits electrical pulses to your scalp which go through your skull to the neurons in your brain. The treatment is painless and is usually performed for 40 minutes, 5 days a week, for at least 6 weeks to provide symptom relief.
We have treatment rooms with comfortable chairs for clients to sit in and medical professionals who will put you at ease. Clients start noticing a difference in their mental health symptoms as soon as two weeks into treatment. At BNI, we want to help you get back to living your life.
BNI Clinics is an outpatient mental health center in Agoura Hills, California that serves clients of all ages. We are run by triple-board certified psychiatrists who center patient care on behavioral neuroscience, holistic treatment modalities, individualized treatment plans and evidence-based therapeutic practices. Call us today at 310-691-5005.
BNI Treatment Centers: Science-based, evidence-backed, compassion-led.
