Is TMS Therapy covered by insurance?
At the present time, TMS Therapy is currently covered by most insurance companies on a case by case basis. Because this treatment is relatively “new” according to the health insurance industry, most insurance plans do not have a clear coverage guideline and, in some cases, it is considered to be an “elective” procedure, despite the inadequacy of other covered treatments. In some cases, a prior authorization approval for coverage may be obtained after the treatment has been prescribed and requested by the attending physician. Most insurance plans are reimbursing patients if they choose to have this treatment before their plan have developed a coverage policy. Because TMS Therapy is becoming more available around the United States and more patients are receiving treatment, insurance plans are actively evaluating their policies on TMS Therapy and we expect benefits to become more widely available by early 2012.
What if my insurance plan denies coverage for TMS Therapy?
If your insurance plan denies coverage for TMS Therapy, we work with theNeuroStar® Care Connection Program –a free service to our patients–to guide patients through the appeals process. This is truly a team effort as we, the providers, compose the necessary clinical information demonstrating the medical necessity of this treatment for the patient, while the NeuroStar Care Connection advocates compile and submit appeals, published journal articles, and additional information from the FDA, American Medical Association, and other governing bodies, which support the use of TMS Therapy as a standard of care in psychiatric medicine. They have also helped to create a group of independent reviewers who are not only psychiatric specialists, but also specialists in TMS Therapy. This ensures that each patient re
ceives a fair and thorough review of their individual case. To date, about 75% of patients who have used this service to the fullest extent have received reimbursement.
If out-of-pocket payment is necessary in order for you to receive treatment now, we are glad to be able to provide several different financing options. Some patients choose to finance their treatments by utilizing their healthcare savings account. Other patients choose to use medical financing offered by Medical Financing, with which we have partnered to offer low monthly payments. You can click on the images below to learn more about each insurance reimbursement and financing available. You may apply online for monthly payment plan with Medical Financing We. will be happy to assist you in determining which kind of financing options work for your budget.