Insurance coverage for TMS has expanded dramatically. TMS is now mainstream.
Is TMS treatment covered by insurance?
Almost all insurance companies cover TMS treatment for MDD but not yet for other diagnoses. The primary exception is Colorado Medicaid. We do accept Medicare. Tricare coverage is available, as well as most other commercial insurances.
Most insurance companies require a prior authorization which we will obtain. Each requires a different history of failures of previous medications in order to pay for TMS treatment. A general rule of thumb is that four medications of different classes and either adequate dose and duration or intolerable side effects are required. Sometimes an augmentation trial must be demonstrated but we have been successful in obtaining authorizations where some of these were lacking.
Will the patient need to pay a copay?
Most insurance plans do require a copay to be paid. If the patient has not yet met their plan deductible for the year this may also be owed. We will work with your patient to obtain an estimate.
We typically require patients to make copayments in pace with services.
Plans may pay TMS from either medical or mental health benefits sides of their ledger, making advance estimates of how TMS will be paid difficult at times. HSA (health savings accounts) pay for TMS. Financing referrals are available but with increased coverage this is seldom necessary. We will work hard to make treatment possible for your patients.