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It is highly recommended that patients work directly with their insurance companies to determine coverage. Contact your insurance company before your first visit to see if TMS is a covered benefit. Many insurance providers have per-certification requirements for TMS and reimbursement can be delayed. So for instance, while the initial assessment for TMS is typically covered by insurance plans, the patient may be on the hook for full payment until reimbursement from their provider. Worse still, the patient may be liable for full payment if TMS isn’t covered at all.
AnonymousDepends where you live. I’m in France and fortunately for me TMS is covered at 100% in the case of severe depression and other major psychiatric disorders.
There’s some really good news about insurance coverage in the U.S.: As of 2014, over 150 million lives have access to coverage for TMS. The Blue Cross Blue Shields are leading the way by pre-authorizing TMS based on medical necessity. But many smaller insurers are following suit. ALL STATES in the U.S. now have coverage (with the exception of UT, ND, IA and WY who don’t have any insurers — but that’s changing as well so stay tuned!
More Good News! There’s a new Transcranial Magnetic Stimulation coverage policy with United Healthcare, effective February 1, 2015. This coverage decision will now provide access to TMS for approximately 63 million members in United States. Members with United Healthcare living outside of the country may also have benefits for Transcranial Magnetic Stimulation. BIG NOTE HERE: Be sure to check with your health care benefits administrator, although there are many times that the person on the other end of the phone hasn’t received the “memo” regrading TMS coverage updates, so make sure your healthcare provider confers with either Neuronetics’s or Brainsway’s reimbursement folks.
It looks like I may be getting the run around with Blue Cross of Ok. Making me more depressed. The waiting is so difficult. Prayers please.
How long do the insurance companies usually take to approve TMS ?? Thanks
As a small correction to Martha–all states in the US do NOT necessarily have insurance plans with TMS coverage. In New Mexico, no individual health plans (bought on the exchange) will cover TMS. BCBS pulled out of the individual market in New Mexico last year. I had to pay several thousand dollars out of pocket even though I have otherwise very good health coverage, because my insurer denied TMS as being “experimental”. I’m currently appealing, although I’ve heard the process can take up to two years.
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