Insurance Coverage For Tms Treatment

0:00Hi, my name is Dr. Emily Ahn, and I'm the Director of Brain Science at the Delray Center for Healing.

0:05Today I want to talk about everything you need to know about how to get TMS through your insurance provider.

0:10Most commercial insurance providers are going to cover TMS treatment,

0:14but what are the requirements to actually get it authorized through your insurance provider?

0:19The three things I like to think about are score, medication, and therapy.

0:23Score refers to a psychometric assessment that quantifies subjective depression,

0:28and this is typically administered in office with your current provider.

0:31If you meet a minimum base score, then you meet the criteria for the TMS treatment.

0:37You also need to consider medication.

0:40Most typical insurance providers are going to require at least two different types of psychopharmacological treatments

0:47within the current depressive episode.

0:49So these are going to be your SSRIs, your SNRIs, or your atypical antidepressants.

0:54Again, these are going to be within the current episode and would need to have been taken for at least six months.

0:59Lastly is therapy.

1:01This is going to be your talk therapy.

1:04Have you been seeing a therapist within the current depressive episode?

1:07Have you given therapy a try?

1:09It doesn't matter so much the type of therapy.

1:11So you can have cognitive behavioral, dialectical behavioral, or even EMDR,

1:15but all constitute as a type of therapy modality that would authorize getting the TMS treatment.

1:21Some insurance companies are going to be more strict.

1:24Some are going to be more lenient.

1:26So it is always important that you follow up with your specific carrier

1:29so you know what the requirements are for your insurance policy.

1:33Once you meet all of that criteria,

1:36a TMS provider will initiate a prior authorization to initiate coverage through your insurance company,

1:42and they will call you to schedule that first appointment when they get your approval.