Is TMS Therapy Covered By Insurance?
As TMS continues to produce positive therapeutic results, insurance coverage broadens substantially.
Insurers have been coming on board in droves—adding TMS coverage to millions of policies nationwide—as mounting data continues to validate the efficacy of TMS treatment for depression. There are variations among the different insurance carriers regarding what specific criteria must be met in order to qualify for coverage, so check with your plan to determine eligibility. Generally, the qualifying criteria include one or more of the following:
Failure to respond to pharmacologic antidepressant treatments
Failure to respond to additional augmentation strategies, and
Failure to respond to some form of psychotherapy, such as cognitive behavioral therapy.
Insurance accepted for Depression Treatment, specifically TMS therapy, has more than doubled in the last few years, a sign that insurance companies must see cost savings in a treatment method for major depressive disorder (MDD) that works more efficiently than the traditional regimen. Patients who continually suffer from the debilitating effects of medication-resistant depression may acquire other health conditions as a result, such as a substance abuse disorder or unhealthy weight gain, to name a few. The fact that more and more insurance companies are providing coverage for TMS indicates a cost-benefit to the insurer, thus the broadening of benefits.
The following are some of the insurance plans currently working with Achieve TMS East:
- Commonwealth Care Alliance (CCA)
- Fallon Health
- Harvard Pilgrim
- Health New England
- Husky Health CT
- Masshealth PCC Plan
- Masshealth MBHP (most providers in network)
- Neighborhood Health Plan
- One Care
- Tufts Health Plan (Together, Direct, Unify, Commercial)
- United Health Care
If you do not see your plan listed above, you are most likely still covered for TMS treatments. To verify your insurance coverage, please contact Achieve TMS East today at (877) 297-5816 to speak to one of our friendly, informed staff members. They’ll be able to answer all of your questions regarding insurance eligibility and acceptance for depression treatment with Transcranial Magnetic Stimulation therapy.