How to Know If My Insurance Covers TMS – Achieve TMS East

How to Know If My Insurance Covers TMS

Transcranial magnetic stimulation is a treatment option for patients with major depressive disorder and other mental health conditions. While still less-known than other more conventional methods for treating depression, TMS has grown rapidly in the public eye, through the efforts of dozens of TMS clinics throughout the country and the work of many doctors and psychiatrists who have spent years researching TMS technology and working with TMS companies to improve protocols and study the efficacy of the therapy.

However, despite its effectiveness in combatting depression, only a few years ago, getting treatment through TMS may have been difficult. Insurance companies did not always cover TMS therapy, although the treatment has been around since 1985. TMS was first officially approved by the FDA for the treatment of depression in 2008, yet news reports dating back as recently as the early 2010s talk about the lack of availability regarding TMS coverage throughout the United States.

That has dramatically changed in recent years. Today, most major insurance companies provide insurance policies that cover TMS treatment, and many TMS providers across the country work in-network with various insurance companies to make sure that their patients have access to all available treatments for their conditions. TMS treatment coverage may even expand to allow OCD patients to seek treatment, as the FDA has recently approved Brainsway’s deep TMS for the treatment of OCD.


Most Insurance Companies Cover TMS Treatment

The exact number of insurance companies that cover TMS treatment differ from state to state, and from clinic to clinic. Companies that have so far provided insurance policies covering TMS in at least one state include Medicare, United Healthcare, Blue Cross Blue Shield, Anthem, Aetna, Magellan, QualCare, Cigna, Allied National, Optum, MHN, and more.


Proving Eligible for TMS Treatment

TMS is currently available as an alternative treatment for major depressive disorder, should a patient:

If a doctor declares that a patient is struggling with treatment-resistant depression, and signs as such, then a request can be made to your insurer to provide coverage for TMS treatment through an in-network or out-of-network provider near you.

You may be treatment resistant if you do find that your medication helps somewhat lower symptoms, at the cost of serious side effects. Note that the road to finding the right medication may be long. It is not recommended to quickly switch between different medications or doctors, as it takes time for the body to taper off one drug and begin reacting to the next.


In Network vs. Out of Network Coverage

In-network treatment providers are clinics and providers that have already set up a contract with your insurance provider. This will typically cost you less than working with an out-of-network provider in the same area.

If there are several TMS providers in your area, a little due diligence can help you find out which providers are currently working with your insurance company, and what their respective rates are.


How Does TMS Work?

Transcranial magnetic stimulation involves the use of a special magnetic coil built into specialized headgear designed to target the patient’s dorsolateral prefrontal cortex, within the frontal lobes. A machine powers the device and sends low magnetic pulses through the coil into the patient’s brain, only a few centimeters deep.

Deep transcranial magnetic stimulation increases the depth of the pulses to up to around 4 centimeters, while most TMS devices reach only about 1.5 centimeters into the brain.

The magnetic pulses interrupt the activities of certain nerve cells, causing the hyperpolarization or depolarization of certain neurons to affect how signals travel through the brain. This minor change has elicited positive reactions in patients with depressive symptoms by helping their brains better regulate mood.

The principle behind TMS technology is simple – without causing damage to the rest of the system, risking memory issues, or causing a seizure, TMS aims to change the way neurons ‘fire’ by affecting the brain’s natural electric pulses with magnetic pulses.

This low-risk, non-invasive method has proven effective not only in targeting depression through the dorsolateral prefrontal cortex but has elicited positive change in patients with other disorders by targeting different parts of the brain, including the pre-supplementary motor area and the orbitofrontal cortex.

Treatments involve exposing a targeted portion of the brain to magnetic pulses for roughly half an hour, five times a week, for the duration of 4-6 weeks.


Why Choose TMS? 

Transcranial magnetic stimulation is a non-invasive, pain-free, and effective therapeutic option for patients with major depressive disorder and obsessive-compulsive disorder. Outside of the United States, TMS has also been used off-label or approved for the treatments of migraines, bipolar disorder, and other mental health conditions.

However, it’s not a magic pill. TMS is statistically most effective in the treatment of patients who do not respond well to traditional treatment options, including psychotherapy and antidepressant medication. In studies of patients with treatment-resistant depression, TMS helped over half achieve a significant reduction in depressive symptoms, and approximately a third achieved total remission.

Others did not improve significantly, and some complained of physical discomfort following early treatment, particularly due to the sensation of the machine. This was especially noticeable among deep TMS treatments, which boast higher efficacy but lower tolerability.

For patients who find the initial session uncomfortable, studies show that subsequent sessions reduce discomfort significantly, as the patient gets used to the physical sensation of the device. Since TMS therapy does not involve any invasive steps and does not cause lasting pain – only mild discomfort – anesthesia is not necessary. Patients who experience headaches after their first few treatments may take over-the-counter painkillers to help reduce the pain.

Although under development and research since the 1980s, much progress is still being made in the research and application of new TMS technologies, potentially providing faster and more effective treatments to patients over the coming years.

Depression is a major mental health disorder affecting millions of Americans, yet there are many other mental health conditions that may be treated through TMS technology. With time, these technologies will also become widely available as alternatives to typical pharmacological treatments.


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