If you’re experiencing treatment-resistant depression, a friend or family member may have encouraged you to try TMS Therapy.
After all, there is nothing that most individuals want more than to live without the weight of their illness. When payment is a barrier, however, the best solutions can feel out of reach.
TMS is an FDA-cleared procedure that is effective against depression. Its non-invasive nature makes it ideal for many populations, including pregnant women. But will Anthem cover TMS?
Read on to learn who qualifies for TMS therapy for depression and how to begin the process.
Neurostar TMS Therapy
Neurostar is a partner of TMS Center of the Hudson Valley. The machine used during your TMS therapy session will be a Neurostar machine, manufactured by Neuronetics. The machine is FDA-cleared for use in the treatment of a major depressive disorder.
The machine will target the pathophysiology of your depression. It does this through high-frequency electromagnetic induction. Dr. Pardell will place the magnets and calibrate the machine for your specific needs so that treatment will always be gentle, painless, and safe.
A Neurostar TMS treatment takes between 19 and 37 minutes per session, over the course of several weeks.
Neurostar TMS treatment has proven effective in 50 to 60% of patients. A third of those patients experienced full remission of symptoms.
Does Anthem Cover TMS Therapy?
The TMS therapy cost should not prevent you from seeking relief. For that reason, it’s wonderful to learn that Neurostar TMS treatments are covered by most major insurance providers, including Anthem.
To qualify for coverage, Anthem patients must first meet four specific conditions. All four conditions must be might for treatment to be approved. Your existing doctor or therapist can provide you with the documentation that you need to provide that you meet each of the following conditions.
First Condition
You must have a confirmed diagnosis of major depressive disorder. The doctor or therapist must be able to document the diagnosis using a standardized rating scale to describe your symptoms. Most doctors and therapists use these scales in-office and will be able to provide this documentation on your behalf.
Second Condition
The second condition requires that you meet one of three criteria. You must be able to show some proof that:
- Your depression is treatment-resistant
- You cannot tolerate medications traditionally diagnosed for the treatment of depression
- ECT is not, or is no longer, a viable option
Anthem defines treatment resistance as “Failure of 4 trials of psychopharmacologic agents including 2 different agent classes and 2 augmentation trials.”
Third Condition
Third, you must be able to document that standard psychotherapy has proven ineffective.
Your doctor or therapist must document this through the use of a standardized rating scale. They can provide a scale taken at the beginning of treatment, along with a more recent rating scale. If the two tests show little improvement over time, Anthem is more likely to approve your claim.
Fourth Condition
Finally, the treatment must be on a list approved by Anthem. As TMS Center of the Hudson Valley is a Neurostar partner and will be able to document this for you. Neurostar is an approved treatment for major depressive disorder.
Relief From Depression Just Became Affordable
If you are living with treatment-resistant depression, TMS Therapy may provide the relief that you’re looking for. Because Anthem covers TMS treatment at TMS Center of the Hudson Valley, you won’t have to worry about payment.
If you are an Anthem patient, you can begin the approval process today. Start by reaching out and contacting TMS Center of the Hudson Valley for a consultation. You will be on your way to living a life free of depression.
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