The FDA cleared NeuroStar transcranial magnetic stimulation (TMS) as a therapy for treatment-resistant depression in adults in 2008. Initially, this therapy was not well known. As more people learn about NeuroStar TMS, access to it is growing, and so is insurance coverage for it.
Understanding how to get insurance coverage for this therapy is crucial so you receive the maximum benefits under your insurance policy. Many commercial insurance providers, Medicare, and some Medicaid plans offer coverage for NeuroStar TMS therapy.
Our medical practice’s skilled professionals would be happy to discuss this treatment’s potential for eliminating or alleviating your symptoms and to explain how insurance coverage for NeuroStar TMS therapy in Decatur could reduce your out-of-pocket expenses.
Most major insurance providers, including TRICARE, Medicare, Aetna, Blue Cross Blue Shield, UnitedHealthcare, and Cigna, cover NeuroStar TMS therapy for Decatur residents who qualify for treatment. Most of these insurance carriers require prior authorization for NeuroStar TMS sessions. This means you must give them documentation demonstrating medical necessity.
The first step is to obtain a qualifying diagnosis. Insurance companies will not pay for your treatment if you do not have one. This means a physician must diagnose you with moderate to severe major depressive disorder (MDD) or anxious depression. NeuroStar TMS therapy is also FDA-cleared for use as an adjunct therapy for obsessive-compulsive disorder (OCD) in adults or as an adjunct therapy for adolescents with treatment-resistant depression.
You must have documentation showing that antidepressant treatments have not improved your mental health. The number of different medications you are obligated to use without getting relief from your symptoms can vary between insurance providers.
One insurance provider may require you to have failed on at least two antidepressants, while another may require three or four failures. Check with your insurance provider before beginning the prior authorization process. You may also need to show that psychotherapy (i.e., talk therapy) has not been successful.
Most insurance companies require a medical clearance for NeuroStar TMS therapy. While the treatment is effective and safe for most people, it is not recommended if you have an implanted metal device, such as a cochlear implant, pacemaker, or deep-brain stimulator. NeuroStar TMS’s magnetic pulses can damage these devices. If you have a ferromagnetic ink tattoo on your head or neck, you are also not a good candidate for the NeuroStar TMS process.
You must take several steps to verify that your insurance provider will cover your NeuroStar TMS sessions at our Decatur location. Begin by contacting the provider directly to ask about your benefits for NeuroStar TMS therapy. Have your policy number ready, and ask what pretreatment requirements or prior authorization requirements you must fulfill. Your insurance company can give you whatever paperwork you need to complete.
We have experience in dealing with various insurance companies and can offer you guidance throughout your insurance approval process. To receive approval, you will have to compile medical records about your previous treatments, your psychotherapy attempts, and any medication trials you participated in.
If your insurance provider denies coverage or your out-of-pocket costs are overwhelming, other options could help pay for your treatment and give you the opportunity to improve your quality of life. Companies such as CareCredit could help provide health care financing options when insurance does not fully cover your treatment.
You also have the right to appeal your insurance company’s decision. You may find out the company just needs additional information or clarification.
Treatment-resistant depression, poorly controlled OCD, and anxious depression are challenging mental health conditions that affect your whole life. The NeuroStar TMS process is increasingly recognized and reimbursed as a safe and effective treatment option.
The process of obtaining coverage can vary between insurance providers. When you are ready to take the next step in your mental health treatment, call our caring team at MindBodySoul Mental Health and Family Practice to schedule an appointment to discuss insurance coverage for NeuroStar TMS therapy in Decatur.
Our team will help you understand your insurance options and determine whether you qualify for coverage of NeuroStar TMS therapy.
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