Treatment Conditions Approved By Insurance For TMS
As per the study conducted by the National Institute of Mental Health, major depressive disorder or MDD is a serious mental health condition that affects more than 16 million Americans every year. Almost 65% of the MDD patients are not seeking the right treatment because of the lack of knowledge regarding the treatment options for major depressive disorder. And even those who receive the treatment may not experience the relief in the symptoms. For these individuals, one promising treatment is transcranial magnetic stimulation or TMS.
TMS is a non-invasive, safe, and proven treatment for people. A coil is placed on the head of the patient that send magnetic currents to the skull to activate the neurons of the brain that are responsible for mood regulation. Authorized by the FDA in 2008, TMS is an effective outpatient treatment where the patient can return to regular activity directly without experience any significant side effects. Thus most insurers cover the cost of TMS treatment. Research shows that TMS therapy helps in avoiding future complications that often result from depression. Then why is it not the first line of treatment? It is because it is tricky to get insurance approval for TMS.
Patients should receive prior authorization by the insurance company for the TMS therapy. The insurance companies consider TMS necessary when an individual meets the following criteria:
I. The individual is diagnosed with moderate to severe Major Depressive Disorder (MDD) with a single or recurrent episode without psychosis.
II. The patient has tried the minimum number of medications for depression at adequate doses, from two different classes of antidepressant medications for almost a month or the documents stating that the individual couldn’t complete the medication trial because of intolerance to particular medication or class of medication.
III. Have adequate evidence that the patient has undergone psychotherapy, a known treatment of Major depressive disorder, with no improvement in depressive symptoms.
The patient coverage team at Fort Lauderdale Behavioral Wellness assesses the coverage and performs a thorough benefit investigation and work carefully to obtain insurance pre-authorization for services, including the complicated task of securing TMS approval.
How to find out whether your insurance company will pay for TMS therapy?
Navigating the bureaucracy of the insurance company is challenging and time-consuming. The best way to find out whether your insurance company covers the cost of TMS therapy or not is by making a quick phone call to the insurance provider on the number provided on the back of the insurance card and ask relevant questions such as:
1. Is the cost of TMS covered in my plan?
2. What percentage of TMS is included in my plan?
3. Is pre-approval necessary?
In the case of pre-approval, it is necessary to get in touch with the Fort Lauderdale Behavioral Wellness and schedule a pre-treatment evaluation with the experts. After the pre-treatment evaluation, the company submits an appropriate authorization form to the concerned insurance company. After the wellness clinic receives the authorization from the insurance company, they coordinate with the insurance company while keeping you in the loop at each step.