The best way to determine if your insurance plan covers TMS therapy is to contact your insurance provider directly. You can call the customer service number on the back of your insurance card and ask specifically about coverage for Transcranial Magnetic Stimulation (TMS) or repetitive TMS (rTMS) for your diagnosis.

When you call, consider asking:

• Does my plan cover TMS therapy?
• What are the requirements for coverage (such as prior authorization or documentation of previous treatments)?
• What is my estimated out-of-pocket cost, including deductible, copay, or coinsurance?
• How many sessions are covered?
• Do I need a referral from my primary care physician?

Additionally, our office can assist you with insurance verification. We can contact your insurance company on your behalf to check your benefits and help determine your coverage and any prior authorization requirements. Many insurance plans, including Medicare, do cover TMS therapy for treatment-resistant depression when certain criteria are met.

We recommend verifying your coverage before beginning treatment so you have a clear understanding of your financial responsibility.

Your costs will vary and are subject to your individual co-pay, co-insurance, or deductible. We also have self-pay options available, including an income-based sliding scale for patients who do not have health insurance or whose insurance does not approve TMS therapy.

While Spravato® is FDA-approved and covered by many insurance plans, out-of-pocket expenses can vary based on insurance coverage, treatment frequency, and available financial assistance programs. For additional information, contact your medical insurance provider, or one of our Patient Advocates at (844) 405-4890.

There are financing options available. We work with two financial lenders:

Advance Care Card: https://advancecarecard.com/for-patients/procedures-covered/ 

M-Lend: https://www.mlendfinance.com/home

Yes! 

When you have been contacted by a Patient Advocate and have filled out the new patient paperwork, our Authorization Department will conduct a Benefits Investigation (BI) with your insurance company.

Once that is complete, we will contact you to review your insurance benefits, including the estimated out-of-pocket costs based on your plan and coverage guidelines. This is only a pre-determination of cost – not a guarantee of benefits.

When we receive prior authorization from your insurance company, and if you are comfortable with the out-of-pocket cost, we will schedule your first appointment.

Payments of benefits are subject to all terms, conditions, limitations, and exclusions of a member’s contract at the time of service.

Prior authorization is approval from a health insurance company that may be required before you may receive services.

Yes! TMS Solutions offers cash-pay treatment options for patients whose insurance does not cover TMS or for those seeking treatment for off-label indications. Pricing is determined on a per-patient basis, and we work with individuals to ensure they have access to the care they need. Contact us for more details.