Check Your
Coverage Today
Check Your
Coverage Today
We understand that navigating insurance can be overwhelming, which is why Mindset TMS works with a wide range of trusted insurance providers. Our goal is to make your healthcare experience as seamless as possible, so you can focus on your recovery.
TMS Insurance Coverage
TMS therapy is an excellent solution for treating major depressive disorder, obsessive-compulsive disorder (OCD), and other conditions, but it requires a substantial investment on the patient’s part. We understand that cost can be a significant factor when considering this innovative procedure. That is why Mindset TMS offers various tools to help patients minimize expenses.
The good news is that many insurance plans cover TMS treatment. Our team assists in verifying eligibility and navigating the process. We are also happy to work with you to explore financing options if necessary. Our team believes that cost should not prevent patients from receiving this life-changing care because it can make a big difference in mental well-being and quality of life.
TMS Insurance Coverage
TMS therapy is an excellent solution for treating major depressive disorder, obsessive-compulsive disorder (OCD), and other conditions, but it requires a substantial investment on the patient’s part. We understand that cost can be a significant factor when considering this innovative procedure. That is why Mindset TMS offers various tools to help patients minimize expenses.
The good news is that many insurance plans cover TMS treatment. Our team assists in verifying eligibility and navigating the process. We are also happy to work with you to explore financing options if necessary. Our team believes that cost should not prevent patients from receiving this life-changing care because it can make a big difference in mental well-being and quality of life.
We Accept Most Insurance Companies
Mindset TMS team strives to make TMS therapy accessible and affordable. We are proud to accept most major insurance companies that cover this treatment. We do not accept medicaid at this time and/or Colorado state medicaid does not currently cover TMS. Common providers include:
Aetna covers TMS therapy for major depressive disorder and other approved conditions once specific criteria are met. Patients with Aetna plans may save a significant portion of costs.
BCBS is one of the largest insurance providers, and many of its plans cover TMS therapy. We are happy to help you navigate the potential benefits.
UnitedHealthcare is a major insurance company that offers reimbursement for TMS therapy for qualifying patients. We will work with the provider to verify coverage and assist in getting pre-authorization for your treatment.
Medicare may cover TMS therapy if specific conditions are met, such as having been diagnosed with Major Depressive Disorder and not receiving benefit from an antidepressant medication. Our team will help you navigate the coverage criteria.
TRICARE may offer military members and their families coverage for TMS therapy. As always, specifics depend on your plan, but we will check everything and help you minimize expenses.
Other Insurance Providers
Mindset TMS also accepts Anthem, Carelon, Beacon Health Options, Kaiser Permanente, TriWest Healthcare Alliance, and VA Community Care insurance plans.
We understand that insurance can be a complex issue. That is why our dedicated team is here to verify your benefits, guide you through the approval process, and answer any questions you may have. If your provider is not listed here or you are unsure about your coverage, do not hesitate to reach out. We will work with you to explore your options and have your TMS covered by insurance.
Eligibility Criteria
Insurance coverage for TMS therapy has specific eligibility requirements that patients must meet. They can vary substantially from one insurance provider to another. For example, for depression treatment, patients must satisfy the following criteria:
- 18+ years old - The FDA recently approved TMS therapy for teens as young as 15 years old. Currently most insurance policies only cover 18+. Despite this, Mindset TMS does offer self pay options to provide TMS therapy for teens.
- Diagnosis of major depressive disorder - Patients must have an official diagnosis from a mental health professional that aligns with diagnostic criteria. A single episode or recurrent major depression qualifies.
- Inadequate response to antidepressants - Patients must demonstrate that they have tried and failed at least 1-3 antidepressant medications of different classes at an adequate dose and duration without achieving remission of depressive symptoms. Most insurers require a minimum of 4-6 weeks of pharmacotherapy.
- Referral from mental health provider - A referral and recommendation for TMS from a psychiatrist, therapist, or other mental health provider is not typically required. Our psychiatrist can provide you with a diagnosis and recommendation for TMS if indicated.
Insurance Prior Authorization Process
We aim to make the process as smooth and stress-free as possible. We are here to help every step of the way. Here’s how the verification process works:
Initial Consultation
Initial Consultation
Our team will gather all necessary information during your initial consultation, including details about your insurance provider and policy. This will allow us to begin the prior authorization process immediately, ensuring no unnecessary delays in your treatment.
Insurance Benefit Verification
Insurance Benefit Verification
Once we have your insurance information, our experienced billing team will contact your provider to discuss benefits. We will check TMS therapy coverage under your plan, confirm limits, and determine if prior authorization is required.
Pre-Authorization
Pre-Authorization
If your insurance provider requires pre-authorization for TMS therapy, we will handle the entire process on your behalf. This involves submitting medical records, documentation of prior treatments, and any other necessary information to secure approval from the company.
Out-of-Pocket Costs and Payment Options
Out-of-Pocket Costs and Payment Options
After we verify your coverage, we will provide a clear breakdown of any out-of-pocket expenses, such as co-pays or deductibles. Flexible payment options and financing plans will also be offered to make treatment as affordable as possible.
Follow-Up and Support
Follow-Up and Support
Our team will stay in close contact with you throughout the process, ensuring that you are informed at every step. If any issues arise, such as coverage denials or delays, we will advocate on your behalf to resolve them quickly and efficiently.
FSA & HSA
Many patients can access Flexible Spending Accounts (FSAs) or Health Savings Accounts (HSAs) through their employers. These financial tools allow them to set aside pre-tax dollars to pay for qualified medical expenses, including deductibles, copays, and coinsurance.
TMS therapy is considered a qualified medical expense for FSA and HSA funds. Patients may use these accounts to help cover their deductible or other out-of-pocket costs associated with TMS treatment.
Our team is always happy to consult patients with FSAs or HSAs. We can explain how to request and use those funds to pay for TMS therapy. Our staff is knowledgeable about all procedures and documentation requirements.
Financing Options
We offer flexible financing through Advance Care Card for uninsured patients, providing a streamlined solution for managing medical expenses. Here are the main benefits:
Competitive rates.
Flexible terms with no prepayment penalties or fees.
Interest-free periods of 6 to 14 months for increased accessibility.
Simple application process for fast decisions.
Treatment scheduling upon approval.
Exceptional customer service throughout your financing journey.
Frequently Asked Questions
What documentation must I show my insurance company to get TMS approved?
You will need your official diagnosis from a mental health professional, records showing past medication trials, and any other documents related to your treatment history. Our team can help collect and submit everything needed.
I have already tried several antidepressants without success. How many medication failures must I show to get TMS covered?
Most major insurance companies request evidence of at least two antidepressant trials of different classes. Our staff will check the specific requirements with your provider.
How long does the TMS approval process take with insurance companies?
Insurance verification and prior authorization can take up to 2 weeks, depending on the company. We do everything possible to expedite approvals so you may begin TMS treatment as soon as you are eligible under your plan.
What if the insurance provider denies my TMS therapy application? How can I appeal?
Our dedicated billing staff has extensive experience successfully appealing TMS denials. We will thoroughly review the reasons for refusal, submit additional documentation as needed, and advocate on your behalf through every step of the appeals process. Many requests get approved.
Is the financing application process lengthy? How soon after approval can I begin TMS treatment?
Our financing partner, Advance Care Card, offers simplified applications that may be decided in several minutes. Once approved, we can schedule your TMS therapy immediately, according to the lender’s terms. Our coordination helps minimize delays.
Ready for Mental Health Transformation?
Schedule your consultation today and unlock the power of TMS therapy for a brighter future.
The staff is so friendly. Dr. Peralta really listens to me and how I am progressing with the treatment and is excellent at explaining the process and answering my questions.
Amazing office, great setting easy location and the Dr was amazing asked great questions and came up with a plan to make me feel better.
Dr. Peralta is very concerned and helpful, she listens and problem solves with you. She also explains TMS in an understandable, relatable manner which also put you at ease while reassuring you. The whole staff at Mind Set is very positive and supportive. I'm really happy I found Dr. Peralta and Mind Set, they have made a true difference in my life.
Dr. Peralta and her staff have continuously impressed me and my wife. We respect and appreciate everything that they do for us and they can definitely do the same for you as long as you follow their advice, help, and protocols.
Everything was conducted professionally. An explanation was given as to what and why everything was being done as it was happening so I felt very comfortable about what was going to happen.