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 clinician who can work directly with cash-pay patients without needing to see a psychiatrist. Call 480-668-3599 to schedule a detailed evaluation.
Many insurance policies cover TMS treatment for some forms of depression and oftentimes 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 two conditions, which begins with a required evaluation by a psychiatrist at the TMS Institute. Following this evaluation, clinic notes are sent to the patient’s insurance provider.
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 with a trial of at least four different medications from at least two different classes of medications)
- Inability to tolerate anti-depressant medication’s secondary side effects after having tried at least four different medications
- History of a good response to TMS in a previous episode (i.e., at least 50% improvement in symptoms with previous TMS treatment)
- TMS may be considered reasonable and necessary as a less invasive option if one is currently receiving electroconvulsive shock 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
Payment Options for TMS Therapies
Depending upon your insurance, you may be evaluated by Dr. Patel, Dr. Tariot, or Dr. Butler. Insurance providers that may cover TMS treatment for MDD and/or OCD include:
- BlueCross BlueShield
- Bright Health
- Cigna (Evernorth)
- Optum/United Healthcare
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.