Insurance Plans & Policies

Access to TMS used to only be available by visiting a psychiatrist. Now, we at the TMS Institute are offering new access levels. Enjoy the convenience of on-site psychiatrists available as well as a triple board certified physician who can work directly with cash-pay patients and those with insurance coverage without needing to see a psychiatrist somewhere else. Call 480-448-2916 to schedule a detailed evaluation.

Insurance

Many insurance policies cover TMS treatment and Spravato for depression, including treatment-resistant depression (TRD), major depressive disorder (MDD). Some also cover TMS for OCD. Coverage for treating other conditions is rarely the norm. We will help you work with your insurance provider if you are seeking TMS treatment for these conditions and/or Spravato for depression, which begins with a required evaluation by a physician at the TMS Institute. Following this evaluation, clinic notes are sent to the patient’s insurance provider for initiation of the prior authorization procedure.

Coverage for Major Depressive Disorder (MDD)

Most insurance policies that provide coverage for Major Depressive Disorder require the following:

Patients must be at least 18 years or older
Resistance to treatment with anti-depressant medications (i.e., lack of significant improvement) is often required.
Inability to tolerate anti-depressant medication’s secondary side effects may also be a determing factor for some insurance plans.
For those who want to do repeat rounds of TMS, a history of a good response to TMS in a previous episode is often required.
As well, TMS may be considered reasonable and necessary as a less invasive option if one is currently receiving electroconvulsive shock therapy
For Spravato: the same as above but may have active suicidal ideations and must remain on at least one antidepressant while undergoing Spravato therapy

Coverage for Obsessive-Compulsive Disorder (OCD)

As of September 2022, Cigna (Evernorth) and some Blue Cross Blue Shield plans provide coverage for OCD treatment if the following criteria are met:

Patient must be at least 18 years or older
Diagnosis of OCD as per the DSM-V guidelines has been made
Has failed two or more medication treatments for OCD as defined as:
- Trial at therapeutic doses for least 8 weeks with no significant reduction in OCD symptoms
- Trial of medications but intolerant to secondary side effects or if contraindicated medically
- An adequate trial of evidence-based psychotherapy known to be effective in the treatment of OCD, but without significant improvement in OCD symptoms

TMS Therapies

TMS therapy is designed to improve functioning in the frontal lobe by increasing activity on the left side of the frontal lobe to reverse the asymmetry that results in depression.

TMS Therapy

Payment Options for TMS Therapies

All patients considering TMS and/or Spravato therapy will need to be evaluated by a physician to determine candidacy. This includes TMS and Spravato for depression and TMS for OCD, which are typically covered by insurance if the patient qualifies.

A deposit of $150 is required to book an appointment, even if you plan to use insurance to cover some or all of the cost of treatment.

In-network plans

Depending upon your insurance, you may be evaluated by Dr. Patel, Dr. Tariot, or Dr. Jasser. Insurance providers that may cover TMS and Spravato treatment for treatment-resistant Major Depressive Disorder (MDD) and TMS for Obsessive-Compulsive Disorder (OCD) include:

Aetna
Allied Health Benefits (uses Aetna network)
BannerHealth
Banner University Family Care – AHCCCS
BCBS
Beacon Health Options
Cigna (Evernorth)
Equality Health
Honor Health ACO/ICP
Humana
Magellan
Medica (Mayo Clinic BCBS)
Medicaid/AHCCCS
Medicare
Optum (all UHC plans go through Optum)
Tricare West – HNFS
TriWest
UHC Community Plan – AHCCCS – Arizona Complete Care (Optum)
UMR (UHC)

Cash Payments

Evaluations are necessary even if the patient will be paying out of pocket and include a mapping session for stimulation strength. Please note that MeRT® and TES therapies presently are not covered by insurance for any indication and are only provided as a cash option.

All treatments, including TMS for depression and OCD, which can be covered by insurance if the patient meets the specific insurance policy guidelines, but insurance guidelines are not fully met, prior authorization is not approved by your insurance, or you are interested in a protocol not currently covered by insurance, we have cash payment options as well as financing options.

Additionally, cash-paying patients are evaluated by triple board-certified Dr. Patel, who has formal training in different approaches to TMS. Dr. Patel will determine if you are an appropriate candidate for TMS, MeRT, and/or TES therapy.