Medical insurance companies typically only cover medically necessary services or procedures. Fortunately for people with treatment resistant depression, Transcranial Magnetic Stimulation (TMS) therapy is now considered medically necessary and is therefore covered by many policies. However, there are some limits to coverage that can vary among insurance providers, so it’s important to check with your benefits administrator before scheduling TMS sessions. Read on for more information about TMS coverage and which insurance companies include it in their policies. 

Requirements for TMS coverage

While TMS can be used to treat conditions other than depression—including bipolar disorder, anxiety, ADHD, migraines, chronic pain and others—insurance policies typically only cover TMS for patients with moderate to severe Major Depressive Disorder (MDD). In addition to a diagnosis, you will need documentation indicating that you have tried at least two medications for depression that have not been helpful. You will also need to show that you’ve attempted to treat your depression with talk therapy, but have experienced little improvement as a result. 

Potential disqualifications for TMS coverage

Some insurance companies might have more restrictive requirements to cover TMS, and some policies might disqualify you for coverage based on certain complicating factors, such as:

  • Pregnancy or nursing
  • Acute risk of suicide
  • Ongoing substance abuse
  • Diagnosed neurological conditions (epilepsy, seizure disorders, dementia)
  • Presence of magnetic-sensitive medical devices or objects (cochlear implants, stents, bullet fragments)

But if you suffer from treatment-resistant depression, and you’re in need of relief, don’t just assume you don’t qualify for TMS coverage with your insurance policy.  Speak with a mental health professional about your condition and the treatments you’ve tried in the past. They may be able to provide you with information that increases your chances of coverage so you can get the treatment you need.   

How to improve your chances of TMS coverage

If you have a short-term medical condition that disqualifies you from TMS coverage, such as pregnancy, you can wait until later to begin treatment. However, you’ll also need to prove that you’ve attempted other treatment options. In order to improve your chances of your insurance policy covering TMS, it’s important to maintain accurate treatment records and honestly report your progress or lack of progress with your doctors. It’s also crucial to follow each treatment as completely as possible, including taking every dose of medication and participating in every therapy appointment. Your insurance might not cover TMS if there are indications you missed doses or appointments. 

Insurance companies that cover TMS therapy

If you meet the requirements for TMS therapy, most major insurance companies will usually cover the treatment, including but not limited to:

  • Aetna
  • Anthem
  • Blue Cross Blue Shield
  • Cigna
  • Humana
  • Kaiser
  • Tricare
  • United Healthcare

Additionally, Medicare and Medicaid also cover TMS therapy if the same requirements are met.  However, coverage might only amount to a certain percentage of the cost (usually 80%).

What to do if TMS therapy coverage is denied

If your insurance company denies coverage for TMS, or you are interested in trying TMS for a condition other than MDD, there are various medical financing programs available to make the treatment accessible. Some providers even offer sliding-scale pay options based on income levels. 

TMS therapy in San Diego

If you or a loved one has been diagnosed with MDD and medications and talk therapy are not working, TMS therapy might be the answer. Pacific Health Systems in San Diego offers TMS therapy along with other mental health treatments, and our team of compassionate professionals are dedicated to improving the quality of life for our patients. For more information about TMS therapy or to schedule a consultation, fill out our contact form or call us at (619) 267-9257.