Insurance Plans We Work With
TMS is covered by most major plans, including Aetna, Medicare, UnitedHealthcare, Cigna, Blue Cross Blue Shield. Not sure whether your plan covers TMS? Call 914-877-1200 and we'll check for you at no cost.
What Insurance Usually Requires for TMS
Every plan sets its own rules, but most require some combination of the following:
- —A diagnosis of major depressive disorder, often moderate to severe
- —Trials of antidepressant medications that didn't help enough or caused side effects you couldn't tolerate (many plans ask for two to four trials)
- —In some plans, a trial of evidence-based psychotherapy
- —No medical conditions that would make TMS unsafe
- —Prior authorization before treatment starts
Coverage for TMS for OCD varies more from plan to plan. We'll tell you exactly what your plan requires.
How We Handle Prior Authorization for You
- 01Benefits check. We contact your insurer about TMS coverage, your deductible and your copay or coinsurance.
- 02Documentation. Dr. Mohammed documents your diagnosis, symptom scores and treatment history.
- 03Submission. Our team submits the prior authorization request.
- 04Decision. We let you know as soon as your plan responds. If a request is denied, we review the reason and appeal when appropriate.
- 05Start treatment knowing your expected out-of-pocket cost.
TipAsk your pharmacy for a printout of your past antidepressant prescriptions. It can speed up approval.
What Affects Your Out-of-Pocket Cost?
- —Whether you've met your deductible for the year
- —Your copay or coinsurance per session (a course is roughly 30 to 36 sessions)
- —In-network vs. out-of-network benefits
- —Your plan's out-of-pocket maximum. If you've reached it, TMS may cost little or nothing for the rest of the plan year
TMS Cost Without Insurance
The cost of TMS depends on the number of sessions in your treatment plan. Call 914-877-1200 for our current self-pay rate. TMS is generally an eligible expense for HSA and FSA accounts; check with your plan administrator.
Medicare Coverage for TMS
Medicare Part B covers TMS for major depressive disorder when the coverage criteria that apply in New York are met, including a confirmed diagnosis and a documented history of medication trials. Medicare Advantage plans set their own rules and usually require prior authorization.
Learn more about TMS for depression or our TMS therapy in White Plains.