Increase your chances of getting TMS treatment coverage.
Please, Cover My Magnets – How you can increase your chances of getting TMS treatment coverage.
Transcranial Magnetic Stimulation (TMS) is a non-invasive, non-systemic treatment that has been approved by the FDA for the treatment of major depression unresponsive to drug treatment as well as an obsessive-compulsive disorder.
A major question in the mind of patients is whether insurance will cover this treatment. The good news is that most insurance companies are now covering this safe and effective treatment for depression. The battle is far from over. However, with studies after studies showing a high response and almost 50 percent remission rate for depression, it is difficult to continue to justify the non-coverage of a valid treatment for depression.
Most successful TMS sessions require at least 4 to 6 weeks of treatment. Each treatment session lasts about 20 minutes and patients are required to have 6 sessions a week. I get it, the idea of taking on the massive insurance companies and the prospects of doing it alone may be daunting and overwhelming. However, the decision to approve TMS sessions is usually based on an individual basis.
At Upstate Psychiatry, we are committed to working with you and partner with you in this journey to ensure that your unique case is presented to the insurance company and that you are aware of all your options.
Below are suggestions to increase your chances of being covered by your insurance company.
1.) Make sure that your physician has made the correct diagnosis of major depressive disorder that has not responded to an adequate trial of antidepressant medications.
2.) Make sure that there is no “biological” cause of the depression such that it can be treated such as hypothyroidism, vitamin or folate deficiency.
3.) Make sure you know what antidepressants you have taken, for how long and if you experienced any side effects.
4.) Make sure your depression has been treated with or you are still in treatment with evidence-based therapy such as cognitive behavioral therapy or dialectical behavioral therapy.
5.) Be aware of any other medications you are taking that may have caused mood symptoms or may increase the likelihood of having a seizure.
6.) Make sure you do not have any ferromagnetic implant close to your head. If you do, please let the treating psychiatrist know this.
Remember, if your request is denied the first time, we will not give up. Insurance companies follow a rigid grid to approve or deny coverage. It may be something as simple as not remembering the dose or the duration of a previous medication taken. You have nothing to lose by appealing a denial. If your claim is denied, find out why and our dedicated professionals at Upstate Psychiatry will resubmit your application.
We at Upstate Psychiatry believe that your health is too valuable to simply give up.
For more information, please call Chelsea at 315-202-4156 or visit us at Upstatepsychiatry.org.
Adekola Alao MD