Finding effective treatment for depression can be challenging, especially when standard options like medications and therapy haven’t worked. For those seeking an alternative, Transcranial Magnetic Stimulation (TMS) may be an option. However, before moving forward, it’s important to understand how this treatment fits into your care plan and what to expect in terms of coverage.
The cost of TMS therapy depends on the clinic and treatment plan. A typical course of treatment, usually 20 to 30 sessions, can range between $6,000 and $12,000. While this might seem expensive compared to traditional antidepressant treatments, research has shown that TMS can be cost-effective in those with major depressive disorder (MDD) who haven’t experienced relief from medication. In fact, two studies have found TMS to be a beneficial alternative for patients who struggle with antidepressant therapies.
Keep in mind that as newer TMS devices receive FDA approval and the overall costs of delivering TMS in clinics change, the price of this therapy may shift.
For those concerned about the cost of TMS, there are many financial assistance options that can help make treatment more affordable. With a growing number of Americans uninsured – and estimated 3.4 million more than in 2023 – it’s important to explore options such as:
These resources can make TMS more accessible for those who need it but are worried about the cost.
Most major insurance providers offer some level of coverage for TMS treatment; however, specific policies may vary by plan and insurer. It’s always a good idea to check with your insurance provider to understand what they cover and any requirements you need to meet for approval.
In California, many major insurance companies cover TMS for patients who meet certain criteria. Some of the insurers that may offer coverage include:
Each insurance company has its own guidelines for approving TMS therapy. For example, Aetna requires the following criteria for coverage:
Other providers, like Blue Shield of California, may have slightly different criteria. For Blue Shield of California specifically, they require the following:
While TMS is a promising treatment, certain factors can disqualify individuals from receiving it. These include:
It’s important to discuss your full medical history with your healthcare provider to determine if TMS is a safe and appropriate treatment option for you.
To verify your insurance coverage for TMS, start by contacting your insurance provider directly and asking for their policy on TMS therapy. Get any necessary referrals or documentation from your physician that support the medical need for TMS treatment as this will often be required.
If your insurance denies coverage, you still have the option to appeal their decision. Your doctor can help you by providing medical justification and with the prior authorization process to improve your chances of approval.
To make sure you fully understand what’s covered, here are some questions to ask your insurance provider:
TMS therapy is typically administered daily over 4-6 weeks, totaling 20-30 sessions, and is FDA-approved for treating MDD in adults who haven’t responded to antidepressant medications. Most insurance companies cover this initial treatment course, especially for patients who have struggled with medication or psychotherapy.
In terms of maintenance TMS treatments, coverage can be more uncertain. Some insurance companies will cover ongoing or follow-up sessions if they are deemed medically necessary, but this often requires extensive documentation and justification from your doctor. Even with the necessary paperwork and proof, some insurers may still deny coverage. It’s important to clarify your plan’s specific policies upfront so you know exactly what to expect.
If you’re considering TMS therapy, talk with your insurance provider and your doctor to fully understand all of your coverage options.
Determining if TMS therapy suits your mental health journey should involve consultation with a qualified professional. At Cura Behavioral Health, we provide comprehensive assessments to help you make informed treatment decisions.
Don’t let a mental health condition hold you back any longer. Schedule a consultation with Cura Behavioral Health today. Our experienced team is ready to answer your questions and create a personalized treatment plan tailored to your unique needs.
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Dr. Kevin Simonson, an esteemed Medical Director at Cura Behavioral Health, brings over 15 years of experience in psychiatry. A graduate from a top medical school, he specializes in the treatment of mood disorders and anxiety, employing a patient-centered approach. His dedication to evidence-based care and his commitment to advancing mental health practices have made him a respected figure in the field. Dr. Simonson’s leadership ensures the highest standard of care for the community at Cura Behavioral Health.
