Insurance Coverage and Costs for TMS Therapy

Costs & Insurance Coverage of TMS

TMS therapy is a cost-effective treatment approach for depression, insomnia, anxiety, OCD, and many similar mental disorders because of its proven long-term benefits. The cost of TMS therapy varies substantially depending on the patient’s particulars and insurance coverage.

TMS’s final sum is determined by a number of factors, including the illness treated, the number of antidepressants the patient has taken without success, the insurance policy protection, e.g., your copay, coinsurance, deductible, etc.

In this article, we’ll address insurance coverage and costs for TMS therapy, its benefits, and how to qualify for a TMS insurance claim. Schedule an appointment for TMS Therapy in Los Angeles, Santa Monica, and Beverly Hills today.

Benefits of TMS

TMS is a targeted, non-invasive approach statistically safer and more successful than any medications and behavioral therapy sessions. The TMS procedure comes with minor side effects, such as slight headaches, lightheadedness, and scalp discomfort while being stimulated.

These effects are transient, lasting only a few minutes after the session ends. Unlike other treatments, TMS has not been associated with any long-term adverse effects, making it a superior treatment worth every penny.

TMS has an astonishingly high success rate. Traditional antidepressants and sleeping pills don’t always work, and when they do, obtaining long-term results is never guaranteed. TMS has a success rate of 75 percent, compared to medications (only 37.5 percent).

Studies conducted by leading TMS clinical providers and researchers have revealed substantial evidence that TMS has efficacy and safety for treating the acute phase of depression in treatment-resistant or intolerant individuals.

Other TMS benefits include:

• There is no need for anesthesia (it’s non-invasive), and it can be easily handled/tolerated by most folks.
• It’s an outpatient procedure, and the individual’s everyday routine habits aren’t disrupted.
• Patients who have struggled with medications have shown improvement pursuant to TMS.
• Patients who have previously had a less than positive reaction to ECT find TMS a viable alternative.
• There is zero evidence of severe memory loss.
• TMS was approved by the FDA in 2008 as an effective treatment for depression.

TMS Costs

When TMS was first introduced, it was considered to be one of the most expensive treatment methods. The early high costs were due to a variety of factors. First, the machine was so expensive that most doctors couldn’t afford to treat patients for any less.

Second, the initial gadgets accessible to the general public cost between $60-100 each session for doctors, implying that doctors needed to make at least $60-100 per session, plus an extra sum to hire a certified TMS technician and other related expenditures.

TMS therapy is now much less expensive, with insurance coverage often available and fewer overall costs. In 2013, major insurance companies like Aetna, Cigna, Blue Cross Blue Shield, Blue Shield of California (Magellan), Anthem Blue Cross, and Medicare began to cover TMS. Consequently, TMS is now considerably more affordable for individuals in need. Of course, patients are responsible for their deductibles and copays (depending on the insurance policy).

• Depending on your plan’s benefit or coinsurance amount, you’ll pay anywhere from $10-$70/session if you’re paying with coverage. To complete the therapy course, you’ll need to attend 36 sessions plus one brain mapping session. Your deductible may have an impact on the amount you’re responsible for.
• The costs will be somewhat different if you’re paying out of pocket. California TMS Clinics has one of the state’s most affordable TMS programs. You’ll find that it is significantly lower than you expected, especially when sessions are ordered in bulk or in advance.

It would help if you remembered that insurance coverage differs depending on the carrier. Some insurance providers, for example, require that the patient try at least four psychiatric medicines from 2 distinct drug families (SSRIs, SNRIs, TCAs, MAOIs, or atypical medications) before embarking on TMS. Other insurance companies are more flexible.

TMS Insurance Coverage Explained

Almost all health insurance companies cover the cost of TMS therapy if the treatment is medically necessary and company-specific standards are met. Of course, even if an insurance company could cover a procedure such as TMS, it’s critical for a potential receiver of these treatments to review the company’s policy for specifics, such as plan limits.

While insurance coverage requirements and costs can vary depending on the company, TMS therapy can sometimes be covered entirely by your insurance provider as well. Most of these insurance companies have a set of requirements that must be met, which include:

• Diagnosis of condition (depression, insomnia, etc.)
• Attempts to treat insomnia with drugs have had no substantial long-term results.
• A history of licensed therapists providing treatment or counseling
• No history of seizures or seizure-related disorders in your family.

Each of these requirements must be met in order for TMS therapy to be covered by insurance. Once you’re sure that you tick all the boxes, you can submit your claim and wait for the insurer’s response. The process usually involves the following, in sequential order:

• A patient advocate will contact you to complete a new patient form.
• The billing staff will conduct a Benefits Investigation (BI) after everything is finished.
• Your insurance carrier determines your benefits, subject to the particulars of your plan at the time the claim is submitted.
• Based on the coverage criteria and your unique benefits plan, they will contact you before treatment to assess your predicted patient liability and insurance benefits.
• This is an estimate of your patient liability and doesn’t imply you’ll receive benefits.
• They will arrange your first appointment after your claim has been accepted.

Call Our TMS Therapy Team for Information on Insurance Coverage and Costs

Nowadays, all insurance providers cover TMS therapy for an authorized diagnosis. Please contact your therapist or psychiatrist to request a reference enabling you to submit a claim for TMS insurance. By undertaking this step, you can figure out if your plan will cover the cost of TMS therapy or not.

At California TMS Clinics, we strongly believe everybody deserves the highest-level mental health treatment possible, regardless of the individual’s financial condition. Please get in touch with us immediately to schedule an appointment if you or a loved one are curious to learn more about insurance coverage and costs for TMS Therapy.