Health Insurance & TMS
TMS therapy is rapidly expanding in the U.S. And as it expands, so too do the questions about its cost and coverage. You’ll be happy to know that in just the past 2-3 years, most major commercial health insurance companies will pay at least some portion of the cost of TMS treatment. Government programs such as Medicare will also help pay. Because USP is an out-of-network provider, most insurance companies will offer a coinsurance policy for TMS. This means that the insurance company is willing to cover a percentage of your bills, but you will be responsible for the remaining balance. Some policies may offer a Single Case Agreement, in which your bills will be considered at the in-network rate, thereby reducing your out of pocket costs. We encourage everyone to know their insurance policies and benefits, so please call your insurance and learn about your benefits for TMS!
As with all forms of treatment, insurance won’t help pay for something without medical necessity. Most insurance companies require proof that you’ve tried and failed at least 2-4 different kinds of antidepressants. Some companies may also require that you’ve tried psychotherapy with little or no improvement. These details will all be discussed by your clinician during your TMS evaluation at USP. If you don’t meet the above criteria and are still considering TMS, tell your provider that you’re interested! Your provider can adjust your treatment plan to accommodate TMS therapy in the future via medication management.
Insurance and TMS coverage can be complex and even intimidating. However, we’re here to help! We have staff who are familiar with insurance policies regarding TMS and can help answer your questions. Please feel free to give us a call and ask to learn more about TMS!