Full Answer
Is ketamine treatment covered by health insurance?
The Toronto-based company said it had established direct billing practices with Medavie Blue Cross, a health insurance provider, that will cover 100% of the costs of ketamine treatments at Braxia’s Canadian Rapid Treatment Centre of Excellence (CRTCE).
Does insurance cover ketamine?
Since insurance providers do not pay for ketamine itself, many clinics bill your plan partly for the treatment while you pay the remaining cost. The total amount payable by you and your insurance will depend on the type of condition being treated and the number of sessions to undergo.
Does Medicare cover ketamine therapy?
Medicare does not typically cover IV infusion of ketamine for depression treatment, but other treatment options may be covered. Ketamine is known to have some antidepressant properties, and a ketamine oral medication and nasal spray are approved by the Food and Drug Administration (FDA) for treatment-resistant depression.
Is ketamine covered by Medicare?
Medicare does not typically cover IV infusion of ketamine for depression treatment, but other treatment options may be covered. Ketamine is known to have some antidepressant properties, and a ketamine oral medication and nasal spray are approved by the Food and Drug Administration (FDA) for treatment-resistant depression. The generic version of the ketamine-derivative medication (esketamine) and the name brand equivalent (Spravato) are approved for use in conjunction with an oral ...
Be persistent
You may get some reimbursement right away or you may have to call and advocate for yourself. You may get a different decision for each representative you talk to (frustrating, I know) but keep trying and tell them your story about just how well this treatment has worked for you.
Mention the insurance gap
Since insurance companies do not have a coverage plan for Ketamine providers, you can point out that this is a gap in overall coverage. Alternatively, you can suggest they treat the infusions as they would any out of network provider deal (this is generally how they treat it when patients have received automatic reimbursement after submitting).
What is a neuromend superbill?
This Superbill itemizes the procedure for insurance companies. Neuromend supplies other supporting procedure-related documentation upon necessity from your insurance company.
Can you use ketamine infusions?
Yes, it can be that simple! And it should be. After all, one study indicates that over 20% of drugs in America are used for non-FDA-approved indications (called "off-label use"), at the discretion of the administering physician. Ketamine Infusions fall within this category.
What is the treatment for depression?
In addition to psychopharmacology and psychotherapy, Dr. Cohen’s office offers Transcranial Magnetic Stimulation (TMS), a medication-free alternative treatment for depression and other disorders; Ketamine, a cutting-edge psycho-pharmacological approach to depression; and pharmaco-genetic testing to help guide the approach to medication.
Does insurance cover ketamine infusions?
Because Ketamine is an off-label treatment, insurance companies do not cover Ketamine infusions for depression treatment. This means that medical appointments for SPRAVATO™ are not covered in-network. However, the nasal spray medication used in SPRAVATO™ is covered by every major insurance provider in-network through Principium.
So, What Is the FDA?
The FDA is the agency that approves the legalization of prescription drugs in the United States. For a drug to gain approval, the FDA must have access to the following information:
Off-Label Medication
Off-label prescribing is a legal use of pharmaceutical drugs that healthcare providers commonly practice.
Why is Ketamine Infusion Therapy Considered an Off-Label Medication if Ketamine is FDA Approved?
Ketamine is an FDA-approved anesthetic and analgesic accessible in operating rooms and emergency centers. However, it is not FDA-approved for the treatment of any type of mood disorder.
Is Ketamine Infusion Therapy Safe Then?
For over 50 years, ketamine has been used safely in millions of patients.
Types of Ketamine Therapy
There are two different types of ketamine therapy: IV infusion and nasal spray. The ketamine IV infusion is administered intravenously into the patient’s bloodstream. This treatment takes effect right away and typically lasts from days to weeks.
Insurances may be starting to recognize the need for available resources for patients suffering from acute depression-related symptoms
Depression is a common medical condition that can encompass serious, life-threatening symptoms. Ketamine can be a potentially life-saving treatment for individuals with suicidal thoughts. Sadly, many people who can benefit from ketamine are unable to afford the treatment.
Intravenous Ketamine
Intravenous ketamine was first used in the ’60s as an anesthetic medicine to treat soldiers in the Vietnam War. Due to the lower incidence of respiratory depression, emergency rooms use ketamine for procedural sedation in both adults and children. After nearly half a century, ketamine continues to preserve its unique corner in medicine.
Insurance coverage for TMS therapy and Ketamine
Nearly all insurance plans, commercial, and government cover transcranial magnetic stimulation (TMS). However, TMS is contraindicated for patients experiencing the most severe depressive symptom – suicidal ideations or thoughts.
Why Doesn't Insurance Cover Ketamine?
As mentioned before, the benefits behind ketamine for mental health struggles are relatively new discoveries. The FDA has yet to approve ketamine infusions for mental health, although this is hopeful to change as the FDA recently approved ketamine nasal spray medication for depression.
How Much Do Ketamine Infusions Cost?
The exact cost of ketamine infusion therapy varies due to the highly individualized nature of the medication. For example, if you are receiving initiation treatments for depression, there will be 4 treatments in total and the ketamine doses will be monitored depending on your needs.
Financial Payment Plans for Ketamine?
Advance Care has been trusted for years providing financing options for patients seeking psychiatric treatments and a myriad of other medical treatments not currently offered under insurance plans such as orthodontics work and cosmetic work. The card has many benefits, such as:
Ready to get started?
Ketamine infusions should be available to everyone, and we here at Virginia Infusion Therapy want to help bring this revolutionary treatment to those who need it most. We would love to hear from you and help you build a better life with ketamine infusions!
Get a Free Consultation Today
Phone consultations only take about 15 minutes with a doctor from Virginia Infusion Therapies. Learn more about how ketamine solves for 70% of depression patients and can solve for you.