Requirements for TMS coverage
TMS Therapy Cost With Insurance Coverage
The cost of TMS therapy will depend on whether you are paying with insurance or not. If you have insurance, you will pay anywhere from $10 to $70 per session. A total of 36 sessions are required to complete the treatment course, plus one additional brain mapping session. Without insurance, TMS can be quite expensive.
TMS Therapy Cost Without Insurance Coverage
TMS therapy is a potential treatment option for some people, but it can be expensive. A typical TMS therapy session can cost between $400 and $500, and most people need a series of sessions to see results. This means the total cost of TMS therapy could be around $15,000. Not all insurance companies cover the cost of TMS therapy, though this may depend on the specific insurance plan. Blue Cross Blue Shield, for example, offers coverage for TMS treatment but only for adult patients who haven’t had success with other therapies or antidepressants. So before pursuing TMS treatment, it’s essential to check with your mental health professional and insurance company to see if you would be covered. Coverage options for TMS therapy may expand in the future as it becomes more popular, which would lower the cost for millions of people.
If you are eligible for TMS therapy, most major insurance companies will cover the cost of treatment. This includes, but is not limited to:
- Anthem Blue Cross and Blue Shield
- Arkansas Blue Cross Blue Shield
- Blue Cross Blue Shield of Alabama
- Blue Cross Blue Shield of Arizona
- Blue Cross Blue Shield of Florida
- Blue Cross Blue Shield of Hawaii (HMSA – Hawaii Medical Services Association)
- Blue Cross Blue Shield of Kansas
- Blue Cross Blue Shield of Louisiana
- Blue Cross Blue Shield of Massachusetts
- Blue Cross Blue Shield of Michigan and Blue Care Network of Michigan
- Blue Cross Blue Shield of Minnesota
- Blue Cross Blue Shield of Nebraska
- Blue Cross Blue Shield of North Carolina
- Blue Cross Blue Shield of Rhode Island
- Blue Cross Blue Shield of Tennessee
- Blue Cross Blue Shield of Vermont
- Blue Cross Blue Shield of Western New York (Under Health Now)
- Blue Cross Blue Shield Federal Employee Program
- Blue Cross of Idaho
- Blue Shield of California
- Blue Shield of Northeastern New York (Under Health Now)
- Capital Blue Cross
- Cigna
- Community Care of Oklahoma
- Emblem Health
- Harvard Pilgrim
- Health Care Service Corporation (HCSC) for BCBS of Illinois, Montana, New Mexico, Oklahoma, and Texas
- Health Net
- Health New England
- Horizon Blue Cross Blue Shield of New Jersey
- Independence Blue Cross
- Independent Health Association
- MVP Healthcare
- Optima Behavioral Health
- Oxford Health Plans
- Premera Blue Cross
- Priority Health
- Public Employees Insurance Agency (PEIA)
- The Regence Group
- Tri-Care
- Tufts Health Plan
- United Healthcare/OPTUM by United Behavioral Health
MEDICARE PLANS
- Cahaba Government Benefit Administrators, LLC
- CGS Administrators, LLC
- First Coast Service Options, Inc.
- NGS (National Government Services, Inc.)
- Noridian Healthcare Solutions, LLC
- Novitas Solutions, Inc.
- Palmetto GBA
- WPS (Wisconsin Physicians Service Insurance Corporation)
MEDICAID PLANS
- Medicaid of Vermont
- Aetna
- Anthem
- Blue Cross Blue Shield
- Cigna
- Humana
- Kaiser
- Tricare
- United Healthcare
Medicare and Medicaid also cover TMS therapy if the same requirements are met, although coverage might only amount to a certain percentage of the cost.
How to Improve Your Chances of TMS coverage
If you have a condition that would make TMS ineligible for insurance coverage, you can wait to begin treatment until later. However, you’ll need to be able to show evidence that you’ve attempted other treatment options first. To improve your chances of insurance policy coverage for TMS, it’s important to keep accurate treatment records and be honest about your progress with your doctors. It is important to follow through with each treatment as prescribed, including taking all medication and attending all therapy appointments. Your insurance may not cover TMS if there is evidence that you missed doses or appointments.
How Can I Get TMS Therapy Covered By Insurance?
If you want your insurance to cover TMS therapy, it is helpful to have a letter from your doctor stating that you have major depressive disorder (MDD). In addition, it can be beneficial if your medical records show that you have received other forms of treatment for MDD, such as psychotherapy, antidepressants, electroconvulsive therapy (ECT), or a combination of ECT and antidepressants. Finally, insurance companies may be more likely to cover TMS therapy if your medical history does not include any previous head injuries.
Potential Disqualifications for TMS Coverage
If your insurance policy doesn’t cover TMS, it may be because the company has restrictions on what types of conditions they will cover, or because of certain complicating factors such as pregnancy, substance abuse, or having a medical device that is sensitive to magnets. However, if you are suffering from depression and need relief, don’t assume you don’t qualify for TMS coverage. Speak to a mental health professional about your condition and the treatments you’ve tried in the past. They may be able to give you information that will help you get coverage so you can receive treatment.
What to Do if TMS Therapy Coverage is Denied
If your insurance company denies coverage for TMS, there are medical financing programs available to help make treatment accessible. Some providers offer sliding-scale pay options based on income levels, so that regardless of your financial situation, you may still be able to receive TMS treatment. If traditional medications and therapies have not been effective for someone you love who has been diagnosed with MDD, TMS therapy may be a good option to consider. This FDA-approved therapy is offered on all our listings along with other mental health treatments.
