19 Dec Understanding Insurance Coverage for TMS Therapy at Southern California TMS Center
Navigating insurance coverage for new treatments can be challenging. We aim to clarify your questions regarding insurance and Transcranial Magnetic Stimulation (TMS) therapy, detailing the prerequisites for coverage as well as information about specific insurers such as Medicare, Medicaid, and Kaiser.
Is TMS Covered by Insurance?
In most cases, yes, TMS is covered by insurance. However, the specifics are important. Insurance companies typically only cover treatments deemed medically necessary. While policies vary across insurers, these are the common criteria for TMS therapy coverage:
* A diagnosis of moderate-to-severe Major Depressive Disorder (MDD) (Note: TMS may not be covered by insurance for conditions such as bipolar disorder, anxiety, ADHD, tinnitus, migraines, or chronic pain. But these are conditions that we can further explore with you.)
* Proof that at least two (sometimes up to four) depression medications have been ineffective.
* An unsuccessful attempt at talk therapy known to benefit depression.
Different insurance companies have additional requirements for coverage. And Southern California TMS Center has a team that is knowledgeable in the various criteria. We can help you determine what requirements are needed with your particular insurer.
Does Medicare Cover TMS Therapy?
Generally, yes, but coverage can vary based on your specific Medicare or Medicaid plan. Medicare may cover 80% of TMS treatment costs after meeting all requirements, including the annual deductible. You may be responsible for the remaining 20% of costs and monthly premiums. Southern California TMS Center locations accept Medicare on a case by case basis, depending on the specific plan.
MediCal / Medi-Medi Insurance and TMS Therapy
MediCal, California’s Medicaid program, does not currently provide coverage for TMS therapy
Does Kaiser Cover TMS Therapy?
Southern California TMS Center is an “in network” center with Kaiser. If Kaiser is your primary insurance plan, please contact your Kaiser provider or psychiatrist and request more information to see if TMS Therapy may be right for you. .
How do you find out if TMS Therapy is covered by insurance for you?
While the final decision lies with the insurance company, we can help determine your TMS Therapy benefits.
Document Your Treatment History and Medication Trials.
Keep detailed records of your treatment attempts, especially if you’ve discontinued medications due to side effects. Honest communication with your doctors about your progress is crucial for accurate documentation.
Know who is your primary and who is your secondary insurance.
A coordination of your benefits is key to not having a surprise later. If you have multiple insurance companies as your coverage, make sure to communicate with our team who is primary and who is secondary.
Call SoCal TMS and let us help you navigate the insurance process
We help all of our patients through the insurance process. So let us help you too.
Insurance and TMS: Guidance for Peace of Mind
So, is TMS covered by insurance? Generally, yes. At Southern California TMS Center, we offer free consultations so we can help you assess your coverage and allay any insurance concerns. Our Care Team will assist you throughout the TMS therapy process, addressing any questions and helping you understand the intricacies of insurance coverage.
With proper research and planning, you can embark on your TMS treatment journey, paving the way for peace of mind knowing your care is covered.