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Transcranial magnetic stimulation (TMS) has helped tens of thousands of people overcome depression, anxiety, PTSD, OCD and other mental health disorders. It has revolutionized mental health care, providing psychiatrists with an exceptionally effective depression treatment with minimal side effects.

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TMS is a newer interventional psychiatry treatment, which uses applied technology to deliver painless magnetic pulses directly to a target area of the brain. TMS can precisely target different areas of the brain to treat different conditions, depending on whether the patient is being seen for depression, anxiety, PTSD, OCD or other condition.

Because TMS is a newer treatment, patients often ask whether TMS is covered by insurance. The short answer is that yes, in most cases, TMS treatment may be covered by medical insurance. However, the answer will depend on the psychiatrist you choose for TMS treatment, your insurance benefits, and your own history of treatment.

Let’s take a look at some specific situations to illustrate when TMS will or will not be covered by insurance.

TMS for Treatment of Major DepressionPeople happy after going through TMS treatment

TMS received FDA clearance in 2008 as a treatment for major depression. Receiving FDA approval is an important milestone that allowed TMS to be marketed for depression treatment and opened the door for insurance companies to cover TMS treatment for depression.

Following its initial approval, TMS has since been approved for different forms of TMS treatment and for treatment of additional conditions, including OCD, smoking cessation, and anxious depression.

It is important to note that just because TMS has been FDA-approved for treatment of a particular condition, it does not necessarily mean that health insurance companies include that treatment as a covered benefit.

Here are some factors that determine whether TMS will be covered by insurance:

Psychiatrists Who Accept Insurance

The first requirement for having TMS treatment covered by your insurance company is that your psychiatrist must be in-network with that insurance carrier. You can find this out in three different ways:

  • Check your insurance company’s online provider directory. Search for your psychiatrist by name and verify they are listed as an in-network provider for your plan
  • Call your insurance company’s member services number. This number is often listed on the back of your insurance card. The member services department can verify whether or not your psychiatrist is in network for your insurance plan.
  • Call your psychiatrist’s office and ask them to verify. The office can confirm whether they are in-network for your plan. You can verify your insurance coverage at Ampelis Health by calling us at 435-776-5909.

At Ampelis Health, we are an in-network provider in Utah with the following insurance companies:

Your Mental Health Insurance Benefit

Insurance companies offer multiple plans. Each plan has unique features, especially regarding pricing and coverage. A service that is fully covered under one plan may require a deductible – or not have coverage at all – under a different plan, even from the same insurance carrier.

That’s why it’s important to verify the specific mental health benefits available under your exact plan, not just a generic statement of coverage. For specialty treatment, like TMS, it is especially important to verify coverage and limitations to coverage for the treatment itself, not just mental health coverage.

You can work with your psychiatrist’s office to verify TMS coverage under your insurance plan, or you can call the member services number for your insurance. Make sure to ask specifically about insurance coverage for transcranial magnetic stimulation (TMS).

Please note, you will almost certainly need a pre-authorization from your insurance company prior to beginning TMS treatment. At Ampelis Health, we work with your insurance company to secure the prior authorization on your behalf.

Your Own Medical History

Insurance companies typically have qualification requirements that need to be met before they will approve TMS treatment. Most insurers require at least two different medication attempts, such as SSRIs or SNRIs, without achieving adequate relief. In addition, most insurance requires that you participate in therapy sessions for a certain amount of time (often 4 weeks) prior to beginning TMS treatment.

Your insurance company may require you to submit documentation of your medication and therapy history as part of the pre-authorization process. If you lack sufficient documentation or you have not attempted the necessary pre-requisites, the insurance company may deny coverage for TMS service.

Denying coverage does not mean you are disqualified from TMS forever, though. It simply means you will need to take steps to meet the prerequisites and then resubmit for approval. These steps could include trying a different antidepressant medication or beginning talk therapy sessions.

A Prescription for TMS

The final requirement to have TMS covered by insurance is to receive a prescription for TMS treatment from a psychiatrist. A psychiatrist will evaluate your mental health, your symptoms, current medications, and other relevant information. Using that information, they will then determine that TMS treatment is appropriate for you.

In Utah, Ampelis Health psychiatrists are available to diagnose and treat your mental health. We have deep experience in helping patients overcome depression, anxiety, OCD, and PTSD through TMS treatment.

We can help you obtain insurance authorization for your TMS treatment, answer any questions you have, and make sure you are qualified and ready to start treatment. Leave depression and anxiety behind for good with TMS treatment at Ampelis Health.

Schedule an appointment at Ampelis Health today to get started.

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