Prescription medications called antidepressants are typically the first approach for treating the underlying causes of depression. However, when symptoms are not relieved after trying two or three medications, the diagnosis becomes treatment-resistant depression.
Thankfully, there is hope to alleviate or eliminate these symptoms using TMS therapy. TMS is a non-invasive approach that uses electromagnetic fields to stimulate brain cell activity and reduce the adverse effects of mental health conditions in individuals. Discover your options for insurance coverage for TMS therapy in Austin and how to obtain this effective treatment.
Most major insurance providers in Austin cover TMS therapy, but coverage varies depending on the provider and the policy. Several factors must be considered, including whether the treatment falls within your insurance policy’s covered treatments for your specific diagnosis.
For example, your insurance policy may cover TMS therapy for major depressive disorder (MDD) but not as an adjunctive therapy for obsessive-compulsive disorder (OCD).
Your treatment provider must also be in-network for your insurance policy. Although your policy may offer some benefits for out-of-network providers, you receive your greatest insurance coverage using an in-network. Additionally, the treatment must be medically necessary.
Medical necessity is the services your healthcare provider prescribes or administers to treat or diagnose an illness or injury that meets acceptable standards. The service must be consistent with your diagnosis, the most appropriate option, and deemed safe and effective.
Insurance companies typically use medical necessity to determine whether a treatment or service should be covered under the terms of your policy. To be medically necessary, the treatment being prescribed must be in accordance with generally accepted standards of practice, be clinically appropriate, not cost more than another service likely to produce the same result, and not be prescribed primarily for convenience.
You can take several steps to improve the likelihood of your insurance covering TMS therapy. The first is to verify your coverage with your provider. Most insurance providers have a member services phone number where you can ask questions about your policy coverage and the documentation needed to cover TMS therapy in Austin.
This might include a letter of medical necessity demonstrating that TMS is the most appropriate and effective option. This will be needed to meet the criteria for prior authorization of your treatment. In addition, your insurance provider must authorize treatment before it is done, or they will not cover the cost.
Typically, insurance policies cover a portion of the cost, and you are responsible for your deductible and copay. Once prior authorization is received, we can help estimate your potential out-of-pocket costs.
If your insurance provider denies coverage, you can appeal the decision. This typically requires further documentation and possibly evaluation or consultation to provide the company with the information needed to make an accurate decision.
TMS therapy offers hope for people with treatment-resistant depression and provides a high level of success in reducing or eliminating symptoms.
We encourage you to call our office and schedule a consultation to learn more about insurance coverage for TMS therapy in Austin. Our dedicated team can help you determine whether your policy covers TMS therapy and estimate your out-of-pocket costs.
